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Full text of "Intelligence assessments of the exposure of U.S. military personnel to chemical agents during Operation Desert Storm : joint hearing before the Select Committee on Intelligence, United States Senate, and the Committee on Veterans' Affairs, United States Senate, One Hundred Fourth Congress, second session, Wednesday, September 25, 1996"

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S. Hrg. 104-867 

INTELLIGENCE ASSESSMENTS OF THE 
EXPOSURE OF U.S. MILITARY 
PERSONNEL TO CHEMICAL AGENTS 
DURING OPERATION DESERT 
STORM 



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BEFORE THE 

SELECT COMMITTEE ON INTELLIGENCE 
UNITED STATES SENATE 

AND THE 

COMMITTEE ON VETERANS' AFFAIRS 
UNITED STATES SENATE 

ONE HUNDRED FOURTH CONGRESS 

SECOND SESSION 



WEDNESDAY, SEPTEMBER 25, 1996 



Printed for the use of the Select Committee on Intelligence of the United States 
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INTELLIGENCE ASSESSMENTS OF THE 
EXPOSURE OF U.S. MILITARY 
PERSONNEL TO CHEMICAL AGENTS 
DURING OPERATION DESERT 
STORM 

Y 4. IN 8/19: S. HRG, 104-867 =^=— ^= 

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BEFORE THE 

SELECT COMMITTEE ON INTELLIGENCE 
UNITED STATES SENATE 

AND THE 

COMMITTEE ON VETERANS' AFFAIRS 
UNITED STATES SENATE 

ONE HUNDRED FOURTH CONGRESS 

SECOND SESSION 



WEDNESDAY, SEPTEMBER 25, 1996 



Printed for the use of the Select Committee on Intelligence of the United States 
Senate and the Committee on Veterans' Affairs "'iV^^-r.^V'- ,. 







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Superintendent of Documents. Congressional Sales Office, Washington, DC 20402 
ISBN 0-16-055153-6 



SENATE SELECT COMMITTEE ON INTELLIGENCE 

[Established by S. Res. 400, 94th Cong., 2d Sess.] 
ARLEN SPECTER, Pennsylvania, Chairman 

J. ROBERT KERREY, Nebraska, Vice Chairman 
RICHARD G. LUGAR, Indiana JOHN GLENN, Ohio 

RICHARD C. SHELBY, Alabama RICHARD H. BRYAN, Nevada 

MIKE DeWINE, Ohio BOB GRAHAM, Florida 

JON KYL, Arizona JOHN F. KERRY, Massachusetts 

JAMES M. INHOFE, Oklahoma MAX BAUCUS, Montana 

KAY BAILEY HUTCHISON, Texas J. BENNETT JOHNSTON, Louisiana 

WILLIAM S. COHEN, Maine CHARLES S. ROBB, Virginia 

HANK BROWN, Colorado 

TRENT LOTT, Mississippi, Ex Officio 

THOMAS A. DASCHLE, South Dakota, Ex Officio 



Charles Battaglia, Staff Director 

Christopher C. Straub, Minority Staff Director 

Kathleen P. McGhee, Chief Clerk 



COMMITTEE ON VETERANS' AFFAIRS 

ALAN ¥L SIMPSON, Wyoming, Chairman 
STROM THURMOND, South Carolina JOHN D. ROCKEFELLER IV, West Virginia 

FRANK H. MURKOWSKI, Alaska BOB GRAHAM, Florida 

ARLEN SPECTER, Pennsylvania DANIEL K AKAKA, Hawaii 

JAMES M. JEFFORDS, Vermont PAUL WELLSTONE, Minnesota 

BEN NIGHTHORSE CAMPBELL, Colorado PATTY MURRAY, Washington 
LARRY E. CRAIG, Idaho 

Thomas E. Harvey, Chief Counsel! Staff Director 
Jim Gottlieb, Minority Chief Counsel! Staff Director 

(11) 



CONTENTS 

Page 

Hearing held in Washington, DC: 

Wednesday, September 25, 1996 1 

Statement of: 

Bryan, Hon. Richard H., a U.S. Senator from the State of Nevada 12 

Campbell, Hon. Ben Nighthorse, a U.S. Senator from the State of Colo- 
rado 10 

Craig, Hon. Larry E., a U.S. Senator from the State of Idaho 9 

Hutchison, Hon. Kay Bailey, a U.S. Senator from the State of Texas 10 

Jeffords, Hon. James M., a U.S. Senator from the State of Vermont 13 

Joseph, Dr. Stephen C, M.D., M.P.H., Assistant Secretary for Health 

Affairs, Department of Defense 24 

Kerrey, Hon. J. Robert, a U.S. Senator from the State of Nebraska 16,120 

Kerry, Hon. John F., a U.S. Senator from the State of Massachusetts 14 

Kizer, Kenneth W., M.D., M.P.H., Under Secretary for Health, Depart- 
ment of Veterans Affairs 29 

McLaughlin, John E., Vice Chairman for Estimates, National Intelligence 

Council 17 

Puglisi, Matthew L., Assistant Director, National Veterans Affairs and 

Rehabilitation Commission, the American Legion 78 

Rockefeller, Hon. John D., a U.S. Senator from the State of West Vir- 
ginia 4 

Shelby, Hon. Richard C, a U.S. Senator from the State of Alabama 7 

Simpson, Hon. Alan K, a U.S. Senator from the State of Wyoming 2,115 

Specter, Hon. Arlen, a U.S. Senator from the Commonwealth of Penn- 
sylvania 1 

Thurmond, Hon. Strom, a U.S. Senator from the State of North Carolina . 6,112 

Wellstone, Hon. Paul, a U.S. Senator from the State of Minnesota 11 

Testimony of: 

Joseph, D. Stephen, Assistant Secretary for Health Affairs, Department 

of Defense 36 

Kizer, Kenneth W., M.D., M.P.H., Under Secretary for Health, Depart- 
ment of Veterans Affairs 50 

McLaughlin, John E., Vice Chairman for Estimates, National Intelligence 

Council 41 

Supplemental material, letters, articles, etc.: 

Central Intelligence Agency Report, dated August 2, 1996 on Intelligence 

Related to Gulf War Illnesses 60 

Article, dated September 6, 1996, from the New York Times 57 

Letter, dated September 25, 1996 from Deputy Secretary of Defense 

to the Honorable Strom Thurmond 56 

Letter, dated January 21, 1997 from Kenneth W. Kizer, M.D., M.P.H., 

to the Honorable Arlen Specter 84 

Letter, dated February 13, 1997 from Mr. John H. Moseman, Director 
of Congressional Affairs, Central Intelligence Agency, to the Honorable 

Arlen Specter 122 

Letter, dated March 10, 1997, from Stephen C. Joseph, M.D., M.P.H., 

to the Honorable Arlen Specter 124 

Department of Veterans Affairs, Annual Report to Congress, Federally 

Sponsored Research on Persian Gulf Veterans' Illnesses for 1995 87 

Article, VA Programs for Persian Gulf Veterans 107 



(III) 



INTELLIGENCE ASSESSMENTS OF THE EXPO- 
SURE OF U.S. MILITARY PERSONNEL TO 
CHEMICAL AGENTS DURING OPERATION 
DESERT STORM 



WEDNESDAY, SEPTEMBER 25, 1996 

U.S. Senate, 
Select Committee on Intelligence and the 

Committee on Veterans' Affairs, 

Washington, DC. 

The Committees met jointly, pursuant to notice, at 10:35 a.m., in 
Room SH-216, Hart Senate Office Building, the Honorable Arlen 
Specter, Chairman of the Select Committee on Intelligence, presid- 
ing. 

Present from the Intelligence Committee: Senators Specter, Shel- 
by, Hutchison, Kerrey of Nebraska, Bryan, Kerry of Massachusetts 
and Robb. 

Present from the Veterans' Affairs Committee: Senators Simp- 
son, Thurmond, Jeffords, Craig, Rockefeller and Wellstone. 

Also Present from the Intelligence Committee: Charles Battaglia, 
Staff Director; Chris Straub, Minority Staff Director; Suzanne 
Spaulding, Chief Counsel; and Kathleen McGhee, Chief Clerk. 

Also Present from the Veterans' Affairs Committee: Tom Harvey, 
Staff Director and Chief Counsel; Jim Gottlieb, Minority Staff Di- 
rector and Minority Chief Counsel; and Stephanie Sword, Sally 
Satel, Dat Tran, Linda Reamy, Dennis Doherty, Elinor Tucker, Jo- 
anne Gavalec, Bill Tuerk and Bill Foster, Staff Members. 

SSCI Chairman Specter. This joint hearing of the Senate Intel- 
ligence Committee and the Veterans' Affairs Committee will now 
commence. Senator Simpson, Chairman of Veterans' Affairs, will be 
joining us momentarily, as will be Senator Kerrey, Vice Chairman 
of the Intelligence Committee. But we've been asked to proceed. 

This hearing is designed to explore what the United States Intel- 
ligence Community knows about exposure and injuries to U.S. serv- 
ice members from Iraqi chemical supplies. We have known for a 
long time that Iraq, Saddam Hussein, have very extensive supplies 
of chemical weapons. We know that they have been used in the 
Iran- Iraq war, that they have been used against the Kurds. And we 
suspect that they may have been used against U.S. personnel in 
the Gulf War as well. 

When the supplies were destroyed with U.S. bombing, there may 
well have been injuries to U.S. personnel where we were not antici- 
pating that there would be the destruction of those chemical sup- 
plies. 

(1) 



In conversations with top officials from the Department of De- 
fense, we have been advised that there were many U.S. personnel, 
perhaps running into the thousands, engineers, who may have been 
exposed to chemical weapons at a time when those weapons were 
being destroyed. 

There may well be a violation of international law by the Iraqis, 
by Saddam Hussein there, and it may well be that reparations and 
damages can be collected from Iraq. Iraq is rich in oil. They have 
not been able to sell very much of it lately because of U.N. sanc- 
tions, but it may well be that we can look to Iraq to compensate 
U.S. personnel on injuries if that is proved to be the case. 

Whatever Iraqi responsibility there may be, there is always the 
responsibility of the United States government. And we will hear 
from Senator Simpson, who has very strong sentiments about that 
subject. He and I have been on this subject since 1981 when he was 
Chairman of the Veterans' Affairs Committee, as he is today. This 
is a subject where I feel very strong, going back to the tales that 
my father told me from his experience in World War I. And we 
have American soldiers on the front line, exposed to chemical 
weapons, where injuries are sustained, and the bottom line is a 
United States responsibility. 

There is a great deal more that could be said, but we have quite 
a number of Senators here and quite a number of witnesses. So, 
I will jdeld at this point to my distinguished colleague, the Chair- 
man of the Veterans' Affairs Committee, Senator Simpson. 

Veterans' Chairman Simpson. That you, Arlen. Thank you very 
much. 

I'm pleased to be present for this hearing to address these recent 
reports that U.S. military personnel may have been exposed to low 
levels of chemical nerve agent in March, 1991 during the post-Per- 
sian Gulf War bunker destructions in Iraq. I'm always eager to 
work with my friend, Arlen Specter, the Ranking Member of the 
Veterans' Affairs Committee, Senator Rockefeller, Senator Shelby 
and certainly others. 

All of us have a great interest in veterans and the care of veter- 
ans. Otherwise, we would not be spending $40 billion a year in that 
course. That is what we spend for veterans each year for their 
health care, disability, compensation, children and spouses. It is a 
very large part of the Health and Human Services budget as well 
as the Veterans' budget. 

We obviously need to know more about the bunker in southern 
Iraq. I've read the August 2, 1996 CIA report on the matter as well 
as statements that have been issued by the DOD. Questions still 
remain. We need more information and it is our intent to try to 
gather some of it today in the most productive way possible. 

This is not, in any way, an attempt today to round up "the ac- 
cused." It is a good faith effort to ground ourselves in the facts so 
that we might be able to perform our jobs in a thoughtful manner. 

As is often the case in dealing with any issue regarding injured 
and ill veterans, many people want to simply sweep aside sound 
medical and scientific evidence on an emotional basis and go ahead 
and spend the money. And I have no problem with that if we have 
the money. If we don't have the money, we've got to figure in the 
Veterans' Affairs budget where to get it. When we add an entitle- 



ment, where do we get the money? Unfortunately, that sometimes 
doesn't puzzle anyone, we just do it. 

It is my hope that by hearing's end, we will have a better under- 
standing, for example, of why the U.N. report was transmitted to 
the DOD in November 1991 and why it was not given more consid- 
eration. Was it because of the ugly fog of war? Those are things we 
would like to find out. Why did chemical detectors not go off when 
the bunker was destroyed by the U.S. forces? What was learned 
from the experience? If errors were made, what can be done to en- 
sure it does not happen again? These are but a few of the questions 
swirling about. We welcome the expert testimony of the VA, the 
DOD and CIA. It will be helpful to hear from these fine and experi- 
enced witnesses. 

I am well aware of the veterans who believe that it is indeed the 
low level nerve agent exposure from the bunker destruction that 
made them ill. Many of them contact me. They speak from their 
hearts. I hear them. Nobody wants veterans who served the nation 
with pride and distinction to be suffering — nobody. It is not the 
issue here today to see whether we leave people to suffer. 

Nobody doubts that many of them are ill. But we do yet know 
exactly what is making them sick. Researchers have not been able 
to conclude that the symptoms are the result of any one unique ill- 
ness. That is why a great research outreach treatment and com- 
pensation effort was set in motion during the 103rd Congress. We 
are continuing with this aggressive response under my watch as 
Chairman of the Senate Veterans' Affairs Committee, and the ef- 
fort will obviously continue long after I retire from the Senate. 

I do want Americans to know of the Federal Government's vast 
involvement with our Persian Gulf veterans. We are not uncaring, 
or unresponsive. Indeed, the VA will speak to that in a few min- 
utes, but I do want to enter into the record two documents that list 
all that the Congress is doing for the sick Persian Gulf veterans. 
It is a remarkable compilation. We are a great nation. We have al- 
located great resources for those who serve in our country's armed 
services. The VA has over thirty — thirty — research projects under- 
way. It has three environmental hazards research centers and it 
has announced the creation of a fourth center. 

The VA has also undertaken a gargantuan epidemiologic survey 
and study. It will compare a representative sampling of 15,000 de- 
ployed Persian Gulf veterans with a control group of 15,000 veter- 
ans who served state-side or in other locations away from South- 
west Asia during the Persian Gulf war. Those results are due in 
1998. 

Congress has also passed legislation requiring that sick Persian 
Gulf veterans be compensated by the VA — even if there is no diag- 
nosis of disease. That needs to be known to the American people 
as we get into these issues of emotion. There are 13 categories of 
undiagnosed illnesses for which a Persian Gulf veteran can be com- 
pensated. Congress has also mandated that Persian Gulf veterans 
receive priority treatment at VA hospitals. 

So, that is a brief compilation of the many, many ongoing Fed- 
eral activities for the Persian Gulf veterans. 

The other agencies included in the multi-agency research effort 
are the Department of Defense; the National Institute of Health; 



the Centers for Disease Controls, the National Academy of Science, 
the Environmental Protection Agency and more. 

I will simply say that this Congress and the 103rd Congress have 
accomplished a great deal for the nation's Persian War veterans. 
Coordinated efforts are underway to treat them, to compensate 
them, and to better understand their ailments. They have been up- 
permost in my mind and in our minds. 

Some of those who are otherwise playing to emotion, fear and 
guilt are doing so regardless of fact. Everyone is entitled to their 
own opinion, but, no one is entitled to their own facts. 

Thank you. 

SSCI Chairman Specter. Thank you very much Senator Simp- 
son. 

Senator Rockefeller, Vice Chairman, the Ranking Member of the 
Veteran's Affairs Committee. 

Veterans' Ranking Member ROCKEFELLER. Thank you, Mr. 
Chairman, very much. And I'm very happy about this joint hearing 
of our Committees today. 

During the last Congress, the priority of the Veterans' Affairs 
Committee was, in fact, oversight of the VA and the DOD response 
to the Persian Gulf War mystery illnesses. We conducted four 
major hearings, crafted legislation to deal with various unmet 
needs, and put out, I think, an excellent staff report. 

So, I'm extremely grateful that you've taken the initiative in call- 
ing us to do this. Now, I have some very strong things that I want 
to say, and they're made out of neither emotion, guilt, or anything 
else, but out of the sense of the constitutional oath that I took 
when I was sworn into the United States Senate. 

The Chairman amply explained the reasons for today's hearings. 
And I will not review again the unfortunate disclosures of chemical 
agent exposures that bring us here. Suffice it to say that with each 
passing week, we hear new revelations of toxic dangers that our 
soldiers faced every day in the Persian Gulf. Dangers which almost 
everyone but the Department of Defense knew or at the very least, 
assumed, were ever present. But the official response is not a pret- 
ty one, I'm afraid, and I wish to talk about that. 

First, there was the giving of an unapproved drug to our soldiers, 
a drug that was meant to be used against a nerve agent that had 
never been detected in the Gulf — a drug which DOD's own re- 
searchers admit could never have worked against the gas we most 
feared would be used, which was sarin. 

Then there were the constant chemical alarms that sounded in 
the Gulf, heard by our soldiers, but the official response was, 
"False alarms, no problem." When other countries or the United 
Nations reported detection of chemical-agent releases, the official 
U.S. response was always, "No independent confirmation, no prob- 
lem." When our soldiers — all of whom were healthy when they left 
for the Gulf, virtually by definition — starting coming home ill and 
asking for help, the official response was more often than not, "It's 
all in your head. No problem." And when there were reports of 
mothers and babies with problems as well, the official response was 
more often than not, "Not related to the Gulf. No problem." 

And now when evidence suggests low-level chemical exposures 
afflicted our men and women in the Gulf, the official response is, 



therefore, not surprising. And that is, "There's no proof of long- 
term health affects from low-level exposures. Therefore, no prob- 
lem." 

Well, the "no problem" attitude is, in this Senator's judgment, 
the problem. And it's time to face the music. Way past time. It's 
time for a change at DOD. 

Sure, the government is doing a lot to find answers and to help 
our veterans. But, I'd have to say that much of that has been 
forced on the Department of Defense by the Congress through leg- 
islation and otherwise. And I'm convinced that the attitude of "no 
problem and we're going to prove it" is what pervades DOD think- 
ing and management of this public health mystery. This thinking 
has survived too long at the peril of too many people, and it is un- 
dermining the credibility and the ability of DOD to do its critical 
health care work. 

DOD's clinical evaluation program, CCEP, is a sad example. 
That's the primary DOD program established to measure the ex- 
tent of health problems following the war. The CCEP found large 
percentages of our soldiers with numerous health complaints, many 
of them serious health complaints. They included 47 percent with 
complaints of fatigue, 49 percent with complaints of joint pains, 39 
percent with complaints of headaches. And the list goes on and on. 

Based on very similar numbers, the Centers for Disease Control 
reported, "Significantly greater prevalence of chronic symptoms" in 
Persian Gulf War veterans. But, not the Department of Defense. 
No. They said the problems that they were finding were not much 
greater than the general population. No particular problem here. 
No problem and we're going to prove it. 

And now comes confirmation of what we all feared, and many 
soldiers already knew — that our soldiers did face exposures to 
deadly agents like mustard and sarin gases. But, since we've been 
so busy tr5ring to prove that there's no problem, we've seen precious 
little — at DOD or elsewhere — to probe the health effects of those 
deadly nerve agents. More importantly, we have seen little effort 
to probe the health effects on soldiers who were exposed to various 
insecticides and repellents, and given drugs to fight nerve agents — 
drugs which may, themselves, have had the opposite effect, drugs 
which may have worsened the effects of sarin. We just don't know 
because we've been too busy proving that we have "no problem." 

As we've all heard over the past few weeks, the Presidential Ad- 
visory Committee on Gulf War Veterans' Illnesses heard what we 
would have to call nothing less than scathing reports about DOD's 
management of the PGW illness investigation. Words like inflexi- 
ble, not credible, superficial, no confidence in DOD's efibrts. 

Mr. Chairman, we can do better and we must do better. That's 
why I've decided to call upon the President to bring new health 
leadership to the DOD. There are many dedicated scientists in and 
out of government that will give their all to get to the bottom of 
these mystery illnesses. And there are some of us in the Senate 
who feel very, very strongly about this and have dealt with many 
of these people and are very, very angry — that is an emotion, that 
is correct — about the lack of attention that they have been receiv- 
ing. But these people who want to get to the bottom of these mys- 



tery illnesses cannot do it while those at the top continue to insist 
that we have no problem. 

It's time for a change, Mr. Chairman, and I thank you. 

SSCI Chairman Specter. Thank you very much, Senator Rocke- 
feller. 

Senator Thurmond, Chairman of the Armed Services Committee, 
would you care to make an opening statement? 

Senator Thurmond. Thank you very much, Mr. Chairman. 

Mr. Chairman, as the senior Member of the Veterans' Affairs 
Committee, and I was there when it was organized — as you know, 
I've been around here a long time — I'm vitally interested in all vet- 
erans and their welfare. The exposure of our armed forces person- 
nel to chemical nerve agents is a matter of great concern. The well 
being of those who served in the Persian Gulf is an issue that I 
have vigorously pursued. As Chairman of the Armed Services Com- 
mittee, I have included provisions in defense authorization bills es- 
tablishing the Persian Gulf War Registry, providing funding for re- 
search, and directing a study on low level exposures to nerve 
agents. 

Of course, under the lead of Senator Shelby, the Committee did 
a study in various nations in the coalition regarding possible expo- 
sure, and I commend Senator Shelby for his good work. In 1994, 
the Department of Defense sent a summary to Congress to report 
the findings of a Defense science board review of Iraq's chemical/ 
biological warfare use during the Persian Gulf War. That summary 
reported that the task force found no evidence of overt intentional 
use of biological or chemical weapons by the Iraqis. Furthermore, 
their investigation found no credible source of low levels of expo- 
sure to chemical weapons, making such exposure unlikely. 

Mr. Chairman, we now know that our troops were exposed to 
nerve agent released as a result of post-war demolition of chemical 
rockets at an ammunition storage area in Iraq. The Pentagon ac- 
knowledged it has known since November 1991 that nerve weapons 
were stored in Iraq but claims it had not realized U.S. troops were 
involved in a March 1991 depot destruction. 

In light of these developments it is critical that the government 
continue to identify those who may have been exposed to nerve 
agents, to assess their health, and to continue to provide medical 
care. 

Mr. Chairman, as we discuss these concerns, let us keep in mind 
that we are dealing with more than words or reports. What is at 
issue is the treatment of human beings, men and women who 
served their country. This Committee has previously heard the tes- 
timony of numerous veterans who went to the Gulf in excellent 
health and returned with various illnesses and disabilities. In- 
cluded in the list of complaints are swellings, headaches, rashes, 
pain in the joints, chronic fatigue, neurological disorders, res- 
piratory troubles, and flu like S3rmptoms. 

I believe both the Department of Veterans' Affairs and the De- 
partment of Defense are concerned for the well being of those who 
served in the Persian Gulf. The Department of Veterans' Affairs 
has taken action to address the many mysteries surrounding the 
various ailments commonly described as Persian Gulf Syndrome. 
Such actions include the establishment of the Persian Gulf Registry 



to provide health exams and health monitoring of veterans, as well 
as the institution of various research programs to identify the 
causes of the unexplained illnesses reported by Persian Gulf veter- 
ans. 

Mr. Chairman, I thank the Chairmen of both the Committees for 
holding this important hearing today. I look forward to reviewing 
the testimony of the witnesses and working with you to make sure 
our veterans are treated fairly and honorably. 

And thank you, Mr. Chairman. 

SSCI Chairman Specter. Thank you very much, Senator Thur- 
mond. 

Senator Shelby, would you care to make an opening statement? 

Senator, Shelby. Thank you, Mr. Chairman. 

Mr. Chairman, I ask that my whole statement be included in the 
record. 

SCCI Chairman SPECTER. It will be, without objection. 

[The prepared statement of Senator Shelby follows:] 

Statement of Senator Shelby, Gulf War Syndrome 

Mr. Chairman, I wish to address what has been a shameful campaign of obstruc- 
tion and delay by the Pentagon and this Administration concerning the Gulf War 
Syndrome. 

Nearly three years ago, I conducted my own investigation as a member of the 
Senate Armed Services Committee and Chairman of the Personnel Subcommittee. 
At the request of a growing number of Gulf Veterans from Alabama suffering from 
unusual and inexplicable illnesses, I traveled to the Gulf and spoke with our allies. 
After interviewing commanders and soldiers directly involved, I concluded that low- 
levels of chemical agents were present in the Gulf theater of operations. I found that 
Czech Chemical Units and other Coalition units accurately reported to Central Com- 
mand Headquarters the presence of chemical agents at various locations. Through- 
out my investigation, our coalition allies were forthcoming and very helpful. 

In contrast with our allies willingness to cooperate, the Pentagon was reluctant 
to provide information necessary to prove or disprove allegations about the presence 
of chemical agents in theater. I was constantly challenged by the Department's eva- 
siveness, inconsistency, and reluctance to work toward a common goal. As the years 
passed, a pattern of denial and delay became standard operating procedure for the 
Pentagon. 

Mr. Chairman, in June of this year, nearly two-and-one-half years after I submit- 
ted my report to the Senate Armed Services Committee, the wall of official denial 
began to crumble. Finally, the Pentagon conceded that American Troops may have 
been exposed to nerve agents shortly afi;er the Army destroyed a weapons storage 
complex in Southern Iraq. At that time, Mr. Chairman, the Pentagon assured us 
that only three to four hundred soldiers were involved. 

Just last week, in the face of overwhelming evidence — evidence, Mr. Chairman, 
that was available over five years ago — the Pentagon finally confirmed what I re- 
ported nearly three years ago and what many Gulf War Veterans already knew. 
Possibly thousands of soldiers may have been exposed to low-levels of chemical 
agents in the Gulf War. 

Why the change in position? Well, the Pentagon now tells us that they "recently" 
discovered that a second destruction site contained an unknown quantity of rockets 
loaded with chemical agents, including the deadly nerve agent sarin. We were told 
that the original destruction would create only a three mile dispersion area. With 
the discovery of the second site, the dispersion area has now grown to fifteen miles 
and may grow further yet. 

What else do we know? 

We know that the Department's Persian Gulf Veterans' Illness Investigation 
Team is aware of at least seven other chemical weapons detections that even the 
Pentagon concedes "cannot be discounted." 

We know that the Pentagon considers the Czech detections of chemical agents to 
be "credible." 

We know that Gulf War veterans know of and have testified to many more chemi- 
cal alarms than the Pentagon is willing to verify. 



8 

For example, members of the 24th Naval Construction Battalion say something 
exploded over their camp in Northern Saudi Arabia on January 19, 1991. As a dense 
mist descended on their camp, they experienced burning skin, numbness, and dif- 
ficulty breathing. We know that their chain of command told them that the explo- 
sion was a sonic boom and that they shouldn't discuss what happened that night. 
Many of those sailors now suffer from inexplicable illnesses. 

One would think, Mr. Chairman, that in the face of an overwhelming body of evi- 
dence, the Pentagon would concede that these exposures could be, at the very least, 
one cause of the debilitating symptoms known as "Gulf War Syndrome." Unfortu- 
nately, Mr. Chairman, concessions by the Pentagon have not been forthcoming. 

Mr. Chairman, I welcome the Pentagon's newly discovered candor after nearly five 
years of denial, evasion and cover-up. But, the Pentagon has a long way to go before 
the whole truth is known. That is why we must keep the pressure on the Pentagon, 
the Veterans Administration, and the President to stay the course and get to the 
bottom of this for the sake of our soldiers, sailors and airmen. 

In hearing after hearing, I have listened to our military commanders tell me that 
their greatest asset is their people. When it comes to Gulf War Syndrome, Mr. 
Chairman, their actions belie their words. 

I cannot tell you why a government that sent its finest into battle remains deaf 
to the desperate cries of its faithful. I have heard their voices, Mr. Chairman, and 
I intend to take action as you have by holding this hearing. I will ask the Chairmen 
of the Defense and VA Committees to also hold hearings so that we can be satisfied 
that all that can be done, is being done. 

We must uncover the whole story of the Gulf War. We must know that our fallen 
heroes are getting all the care that they need. We must also ensure that we are 
preparing our troops for similar threats in future conflicts. 

If we lack knowledge, we must gain it. If we lack resolve, we must marshal it. 
If we lack the courage to face the truth, we must find it. That much, Mr. Chairman, 
we owe those who served with honor and distinction and risked everything, simply 
because we asked them to. 

Senator Shelby. I have a few brief remarks here. 

I'm pleased, Mr. Chairman, and I want to commend you for hold- 
ing this joint hearing on what has become known as the Gulf War 
Syndrome or the exposure of our military personnel to chemical 
agents during the Gulf War. However, I must tell you that I'm very 
disappointed with the Pentagon and this Administration regarding 
this matter. In particular, I'm disappointed mainly because it had 
directly affected our troops, and I believe we all have a responsibil- 
ity to ensure their health and their welfare. 

Just last week, Mr. Chairman, in the face of overwhelming evi- 
dence, evidence, Mr. Chairman, that was available over five years 
ago, the Pentagon finally confirmed what our Gulf War veterans al- 
ready knew, that thousands of our troops were exposed to chemical 
agents in the Gulf War. And Mr. Chairman, once again I cannot 
help but observe that while our Pentagon talks about force protec- 
tion of our troops having a very high priority, that the Defense De- 
partment talks about its concern about the health and welfare of 
its soldiers. Marines, airmen, and sailors, its inactions, the Penta- 
gon's inactions, its delays, its misplaced reports, its incomplete 
data after five years, Dr. Joseph, all point toward an Administra- 
tion that cautions on the side of what looks good in the eyes of the 
press. 

The issue, I believe, is a shameful campaign of obstruction and 
delay, really delay here. I'm concerned about the Defense Depart- 
ment's reluctance to assist our Gulf War Syndrome vets, the de- 
partment's lack of caring of its own troops and the fact that our 
vets are having to prove their own case. 

My bottom line fear, Mr. Chairman, is that we find out that the 
Gulf War Syndrome may have been the direct result of U.S. De- 
fense Department action. This past week's — or this week's News- 



week Magazine notes that in October 1991 the U.N. submitted a 
report that has suddenly reappeared from a Washington file draw- 
er. This report, which I have not seen, indicates that the U.S. 
Army's 37th Engineer Battalion had twice blown up sarin-filled 
rockets, setting off huge plumes of smoke and dust that carried 
deadly debris downward, possibly exposing as many as 25,000 U.S. 
troops. In addition, another article in the same Newsweek issue de- 
scribes the deadly combination of an anti-chemical drug taken by 
400,000 U.S. troops and a widely used desert insect repellent used 
by thousands of these same troops. 

Thus, I believe there is information that suggests that the U.S. 
government is responsible to a degree for the Gulf War Syndrome. 

Mr. Chairman, I look forward to hearing from the witnesses, but 
this is a matter that's not going to go away, shouldn't go away, but 
should be ventilated, exposed, and we should do something for our 
veterans. 

SSCI Chairman Specter. Thank you very much. Senator Shelby. 

Senator Craig, would you care to make an opening statement? 

Senator Craig. Thank you very much, Mr. Chairman. 

I will be brief, but I did want to express my concern along with 
my colleagues here today. And I thank you and Senator Simpson 
for agreeing to hold this joint hearing. 

I, like most of us, have been briefed many times on the topic of 
chemical weapons' use during the Persian Gulf War and have fol- 
lowed very closely announcements about the destruction of the 
chemical plants by our forces, and the destruction in Kamisiyah. 
All too often, briefings I have received provided new information 
which challenged or even contradicted the information received ear- 
lier. I have reviewed the testimony of veterans who argue that they 
left America as the finest, healthiest force this nation ever pro- 
duced, only to come home sick with vague symptoms. 

Initially these claims were discounted. But as more and more 
veterans come forward with similar symptoms, we cannot continue 
to ignore them. And these Committees will not ignore them. You've 
heard the Senator say already, there's been tremendous action, tre- 
mendous effort to find, and now, of course, the great revelations 
are occurring. 

The search for answers is never an easy task. However, the an- 
swer to the questions about what, if anything, has happened to our 
Gulf War veterans is one which we will not ignore and cannot be 
ignored any longer. If we have the answers for these mysterious 
ailments, we have a responsibility to give these veterans full disclo- 
sure. If there are no answers, the government must ensure that 
these same veterans have options available to enable them to seek 
the help, which they need. 

And so I thank you very much, Mr. Chairman. And I ask unani- 
mous consent that my full statement become a part of the record. 

SSCI Chairman Specter. Without objection, your full statement 
will be made a part of the record. 

[The prepared statements of Senator Craig and Senator Camp- 
bell follow:] 



10 

Statement of Larry E. Craig, United States Senator 

Mr. Chairman, I look forward with great interest to this hearing on the subject 
of mihtary personnel exposure to chemical agents during the Persian Gulf War. Be- 
fore we begin however, I just want to add my personal appreciation to the comments 
of the many others who have previously recognized Senate Veterans' Affairs Com- 
mittee Chairman Al Simpson for his many years of dedication and service in sup- 
port of veterans and veterans issues. Senator Simpson (Al). You will be sorely 
missed. 

I have been briefed many times on the topic of chemical weapons use during the 
Persian Gulf War and have followed very closely the announcements about the de- 
struction of chemicals by U.S. forces in Khamisiyah. All too often, briefings I have 
received provided new information which challenged or even contradicted informa- 
tion received earlier. I have reviewed the testimony of veterans who argue that they 
left America as the finest, healthiest force this nation has ever produced only to be- 
come sick vfith vague symptoms upon their return home. Initially, these claims were 
discounted, but as more and more veterans come forward with similar symptoms, 
we cannot continue to ignore that which we cannot explain. 

The search for answers is never an easy task. However, the answers to the ques- 
tions about what, if anything, has happened to our gulf war veterans is one which 
we cannot ignore. If we have the answers for these mysterious ailments, we have 
a responsibility to give these veterans full disclosure. If there are no answers, the 
Government must ensure that these same veterans have options available to enable 
them to seek the help they need. 

Mr. Chairman, answers are all that I am looking for. And, I suspect that is what 
our veterans want as well. Once again, thank you for scheduling this hearing to let 
us hear firsthand, more about what actually occurred during the Persian Gulf War. 
Using the benefit of hindsight, we may arrive at different solutions today from those 
anticipated five years ago. 



Statement of Senator Campbell 

Mr. Chairman, I would like to thank you for allowing me to submit my statement 
for the record as my recent accident unfortunately prohibits me from taking part 
in today's hearing. It is particularly unfortunate that I can not be at this last hear- 
ing of the 104th Congress to personally thank you for your outstanding and memo- 
rable leadership as chairman of the Senate Veteran's Affairs Committee. Your com- 
mitment to the needs of the veterans of this country, along vdth your wit and wis- 
dom, have made for a leadership style that will not be repeated nor forgotten. You 
will truly be missed. 

I appreciate your convening today's hearing which vrill examine recent reports 
that indicate U.S. military personnel were possibly exposed to chemical nerve agent 
during post-Persian Gulf War bunker destructions in Iraq. 

Although the past actions of the Department of Defense regarding this are pres- 
ently uncertain, I am concerned with the possibility that the DoD could have with- 
held information concerning the exposure of U.S. military personnel to nerve agents 
during their service in the Persian Gulf War. In the particular instance that we will 
examine, several thousand troops may have been exposed as many of those involved 
report chronic illnesses that they believe to be linked to this exposure. I certainly 
hope that we are able to clarify this information and its negative implications so 
that together we may move on to taking care of the our aftlicted veterans. 

I know that neither the members of this committee, nor the veterans of this coun- 
try want to see a repeat of the Agent Orange fiasco of the Vietnam conflict in which 
thousands of veterans were given false information about their condition and later 
died from their exposure. It is wrong to expect our young people to go to war, place 
their lives in danger, and then return, only to be forgotten during peacetime. 

I thank the chair, and please know that I look forward to reading the record of 
proceedings and testimony which you have all submitted. 

SSCI Chairman Specter. Senator Hutchison, do you care to 
make an opening statement? 

Senator HUTCHISON. Yes, thank you, Mr. Chairman. 

We have heard of the Kamisiyah munitions depot in southern 
Iraq that was blown up by the 37th Engineering Battahon. There 
was clearly a lack of communication between the CIA, the United 
Nations, and our Department of Defense about whether we knew 



11 

that our Army had, in fact, blown up this munitions depot and 
whether there was chemical weaponry in there. But in fact, it has 
been confirmed that there was a nerve agent released as a result 
of that in a CIA report. 

Now that we have put all of this together, rather than look back- 
ward, except for learning experiences, I think it is important that 
we do everything possible to try to work with the people that have 
possibly been exposed to this nerve gas and other chemicals that 
might have happened in the Persian Gulf, because now in addition 
to all the symptoms that we're hearing about, it appears that there 
are birth defects in the children of these veterans. 

I think we need to stop talking about whether this is the DOD 
responsibility or the Veterans' Affairs responsibility. We need to 
start documenting everything that is happening to those people 
who might have been exposed to this kind of chemical and see if 
there are, in fact, now more birth defects that are occurring in the 
children of these veterans. We need to have good, solid data regard- 
less of whose responsibility it is. We need to err on the side of 
doing too much, not on the side of doing too little. 

I am very pleased that all of you came. I appreciate it. I hope 
that at the end of this hearing, if there are questions at all, that 
we would go forward to do too much rather than use as a hook that 
there are questions and therefore we do nothing. 

Thank you. 

SSCI Chairman Specter. Thank you, very much Senator 
Hutchison. 

Senator Wellstone. 

Senator Wellstone. Thank you, Mr. Chairman. I, too, will be 
very brief so we can get right to the testimony. 

I just want to say two quick things. One is I remember Senator 
Rockefeller, I think it was in August of '94, when we had a hearing, 
and we had some Persian Gulf veterans coming in, and we also ac- 
tually had some atomic vets. And there was, I think, unfortunately 
a similar pattern. With the atomic vets, we go back to the early 
'50s, they had been talking about their health problems and ill- 
nesses, and those of their children. And, you know, people kept say- 
ing we don't have enough information. They're wrong. And, of 
course they're still waiting for just compensation. 

Then I remember we had some Gulf veterans talking in very per- 
sonal terms about burning semen and very graphic personal testi- 
mony. And it was as if nobody believed them. 

And so I just think that this hearing is extremely important. 
There are some — I'm not here to point the accusatory finger or to 
take cheap shots at anybody, Mr. Chairman — but I think there are 
some really tough questions that need to be answered. 

I'm just going to mention two that I'm very interested in. And 
I'll just read them. 

One is why did the DOD maintain that no chemical agents were 
detected and no chemical munitions were forward deployed in for- 
ward areas occupied by the United States in the Gulf when it had 
information for nearly five years that an Iraqi munitions depot de- 
stroyed by U.S. troops on March 4, 1991, contained chemical weap- 
ons, exposing them to mustard gas and sarin, a nerve agent? This 



12 

is a why question. This is the sort of question that troubles veter- 
ans, their famiUes and all of us. 

When first announcing this incident on June 21, DOD estimated 
that 300 to 400 American troops may have been exposed to nerve 
and mustard gas. Early this month, investigators for a Presidential 
advisory panel said that they believed as many as 1,100 were ex- 
posed in that incident. However, just last week, the Pentagon an- 
nounced a second low-level exposure to chemical weapons also oc- 
curred in March, 1991, six days after the first exposure and two 
miles from where the first incident took place. 

Consequently, the Pentagon said it would warn 5,000 Persian 
Gulf veterans that they may have been exposed to nerve gas, and 
the DOD spokesman added, Mr. Chairman, quote, "It was possible 
the number will grow," end of quote. 

Is it any wonder — and I'm sorry, I'm not trying to take advantage 
of the situation, and I feel like it's almost too easy to do and I don't 
want to do that — but just to pose the question to set the mood for 
this very important hearing — and thank you, Mr. Chairman, for 
taking the initiative — is it any wonder that our Persian Gulf veter- 
ans question the Pentagon's credibility on this issue and strongly 
suspect a cover-up? I mean, given the kind of information that 
keeps trickling out and given the contradictions. 

So, Mr. Chairman, I think it's going to be a tough hearing. I 
think each one of these witnesses are professionals. I think it's very 
important we listen to them. But I, too, find myself indignant about 
what's happened to the veterans and the fact that not everyone has 
been as forthcoming with information, as I wish they had been. I 
hope this hearing will really provide us with that information. 

My final point — and I know, Mr. Chairman, it's beyond the scope 
of this hearing — is that I hope right now, the way compensation 
is — I understand, this wdll take 30 seconds — you've got to show that 
the illness has occurred within two years after having served. I've 
got to tell you, with all the information that's coming out. Dr. 
Kizer, we've got to change that. Not to do so would be patently un- 
fair to the Persian Gulf veterans. 

SSCI Chairman Specter. Thank you very much, Senator 
Wellstone. 

Senator Bryan. 

Senator BRYAN. Thank you very much, Mr. Chairman. 

We live in a time in which there is a rising tide of public cyni- 
cism directed at government at all levels. Sadly, many Americans 
believe that their government lies to them, consciously withholds 
information, misleads them. I must say that the manner in which 
this information with respect to the so-called Gulf Syndrome — the 
fatigue, the headaches, the decreased short-term memory, rashes, 
pain in the joints, all of which we've heard a great deal about over 
the past five years — gives those citizens very little comfort that the 
government has been candid and forthcoming. 

We were assured for a period of five years that none of our troops 
were exposed to chemical weapons in the Gulf. Notwithstanding 
the request of this Congress, thousands of veterans, some 60,000 
of which have received medical examinations as a result of con- 
cerns about their health as a result of their service in the Gulf, we 
were told no one was exposed. Now in June, suddenly, as my col- 



13 

league, Senator Wellstone points out, we learn that there was expo- 
sure. And the question arises — as he points out — why was it for a 
period of five years, notwithstanding repeated requests from veter- 
ans, from members of Congress, from others, that we were assured 
that there were no chemical weapons that our troops were exposed 
to. I mean, I must say that I'm eager to hear the response. But this 
kind of action is simply unacceptable. We have to do a better job 
if we're to retain any kind of credibility. 

And now, we're facing a moving target, as Senator Wellstone 
pointed out. From 300 to 400 the numbers suddenly leaped to 1,100 
and now 5,000 and we're told that there may be many more. 

I must say, Mr. Chairman, and I do commend you for convening 
this hearing, the American public and particularly those veterans 
whose health has been effected as a consequence of their service 
deserve an explanation. And they deserve more than just, well, 
we're going to get to the bottom of this. They need to be provided 
answers now. 

So, I'm most interested, Mr. Chairman, to hear the response from 
our witnesses as to how this unfortunate situation and the han- 
dling of it has evolved. 

And I thank you, Mr. Chairman. 

SSCI Chairman Specter. Thank you very much. Senator Bryan. 

Senator Jeffords. 

Senator Jeffords. Thank you, Mr. Chairman. 

I appreciate you holding these hearings. To me, it's incredibly im- 
portant that we find what happened here. I, too, was present when 
we received testimony years ago that there was no evidence of any- 
thing occurring. And all of a sudden now we find this evidence. We 
find ourselves, once again, discussing the disturbing issue of the 
Persian Gulf War syndrome. 

This morning our focus turns to the Department of Veteran's Af- 
fairs and Defense, in particular the VA's health activities for the 
Persian Gulf veterans, as well as the DOD's failure to provide cru- 
cial information until five years after demolition operations of the 
U.S. Army's 37th Engineering Battalion immediately following the 
Gulf War. 

The issue of the Persian Gulf W.or syndrome has troubled me for 
some time. Congress has continued to try and address the problem, 
its medical aspects as best we can with the evidence available to 
us. Efibrts by the Senate and the House Veterans' Affairs Commit- 
tees have yielded some very positive results. The Persian Gulf War 
Veterans Benefit Act of '94 was a bipartisan effort and authorized 
the Secretary of Veterans' Affairs to provide treatment and com- 
pensation for Persian Gulf War veterans suffering from 
undiagnosed illnesses manifested during the war. 

Congress also gave the VA the authority to disseminate research 
grants for government, non-government and academic institutions 
on possible causes and treatment of the Gulf War syndrome. I un- 
derstand that Chairman Simpson has spoken on this matter, so I 
will not go further. 

I have had the opportunity to review some of the material before 
us today. The first question that comes to my mind is why the 
United Nations Special Commission report took five years to sur- 
face. Also, why the DOD dismissed the report in November of 1991 



14 

as irrelevant, and why there was not even an attempt to check the 
vahdity of the report by the DOD back when it was released. 

There are larger, less explainable questions that may not be an- 
swered here today. How are our veterans expected to keep their 
faith in the Defense Department that at best failed to closely exam- 
ine important evidence, while repeatedly and confidently stating 
that they had no evidence linking veterans' illness and the expo- 
sure of our soldiers to chemical or biological weapons. Also, how is 
Congress expected to make educated decisions to provide veterans 
treatment, and compensation too, in light of DOD's handling of the 
documents which were released. 

Had the Presidential advisory panel not reexamined the 
UNSCOM report we would not be holding this hearing. And veter- 
ans who were exposed to nerve agents would continue to be com- 
pletely mystified as to why they're sick. I understand the enormous 
cost to the Federal government by providing life-time treatment 
and compensation to everyone of some 60,000 veterans in the Per- 
sian Gulf registry. However, we should know by now from many 
previous experiences on veterans' illness and military service, the 
only way to come to solid conclusions based on scientific evidence 
is be honest, open and thorough from the beginning. Our veterans 
have earned that much and more. 

Thank you, Mr. Chairman. 

SSCI Chairman SPECTER. Thank you very much, Senator Jef- 
fords. 

We frequently don't go to opening statements but we have today 
because this is, if not the first, one of the first hearings on this sub- 
ject and I thought we ought to set the stage. We have a large group 
and it's been sort of a rolling arrival of Senators. 

We'll now turn to Senator Robb. 

Senator ROBB. Thank you, Mr. chairman. 

In view of the number of Members participating in this hearing, 
I will not make an opening statement. I thank you and Chairman 
Simpson for holding this hearing. It's on a topic that has concerned 
many of us over a long period of time. And anything that we can 
do to provide factual answers to difficult questions will be very 
much appreciated by a very large segment of our population. I 
think that the intelligence aspects of this are important. I also 
think the fact that we're having a joint hearing is a good sign, and 
I thank you. 

SSCI Chairman Specter. Thanks very much, Senator Robb. 

Senator Kerry of Massachusetts. 

Senator Kerry of Massachusetts. Mr. Chairman, thank you very 
much. 

Just a very brief comment, if I may. And I thank both you and 
Senator Simpson for holding this hearing. I'd also like to thank, if 
I can. Senator Rockefeller for his steadfast attention to this issue. 
He really started fighting this battle before anybody else in the 
Congress several years ago. And he did it because he was listening 
to the complaints of a lot of veterans that a lot of us were hearing. 
And there are really two levels on which I think we should express 
concern here today about the hearing. 

I think all of us read the recent articles about new evidence with 
significant consternation, and some increased measure of concern 



15 

for the accountability process. And so, it's important to have this 
hearing to really begin to sort the series of questions that have 
been posed, and responses to them over a period of time, and now 
the real state of the evidence. 

There's another level on which I think we all ought to express 
some concern. There is a great reminder to me in this of the long 
battle we fought with respect to Agent Orange, and presumptions 
about cancer and exposure to spraying, and the long fight that vet- 
erans have to engage in in order to get the government that em- 
ployed them to respond to their needs. It was too long a fight. And 
I personally am very concerned that now a whole new wave of vet- 
erans are going through a similar process. 

Some of us were over in the Gulf within hours of the end of the 
war. I know John Warner was there, along with myself, the later 
John Heinz, and a few others. And I will never forget flying 
through a layer of dark cloud, and coming out where the sun 
ceased to exist, and there was just blackness with fires everywhere. 
And I remember just on the level of air we were breathing being 
very happy to leave after a few hours, and talking to some of the 
young soldiers there who were exposed to just that quality of air 
over a certain period of time. 

My attitude has always been that those people deserve presump- 
tion. And I think there has been a great sort of still-arm attitude, 
fundamentally by those who responsibility it is to make sure that 
people who serve their country, and put on the uniform of our 
country and go into harm's way, are given every presumption in 
their favor. 

So, this hearing serves two purposes. It's really to try to clear the 
history with respect to that treatment and guarantee that perhaps 
there is an attitudinal shift as well as to try to determine the facts 
of what happened and what specific cause might be behind the so- 
called Gulf War syndrome. 

And I thank you, Mr. Chairman, for engaging in this. 

SSCI Chairman Specter. Thank you very much. Senator Kerry. 

Since the hearing began, I have been provided with a copy of a 
letter dated today sent by the Deputy Secretary of Defense — the 
Secretary of Defense, I understand it, is out of the country. The let- 
ter is sent to Senator Thurmond in his capacity as chairman of the 
Senate Armed Services Committee. Neither Senator Simpson, head 
of Veterans, nor I received a copy — a little strange. And I think it 
is worth noting that the Department of Defense now notes that at 
the end of the Gulf War, American troops moved rapidly through 
Iraq destroying ammunition storage facilities. 

And it goes on. Another line says, the troops were unaware of 
this at the time. At this time, we do not know if U.S. troops were 
exposed to toxic chemicals during these events. A little strange that 
the Department of Defense at this point does not know whether 
U.S. troops were exposed to toxic chemicals during these events. 

One of the purposes of having extensive statements made by the 
Senators today, is to show the very strong sentiment of the Senate 
and concern and really sort of disgust about what the Department 
of Defense has done. And then Deputy Secretary White says that, 
I am today initiating a number of immediate and long-term activi- 
ties with regard to the department's efforts toward this issue. 



16 

But I think it is significant that it is done on the day when these 
hearings are convened, that there is suddenly a response which un- 
derscores the need for Senate oversight. It wasn't sufficient that 
several weeks ago that the investigators for the President's Advi- 
sory Commission said that the credibility of the Defense Depart- 
ment has been gravely undermined by it's inquiry into the Iraqi 
chemicals injuring U.S. troops. 

And just 30 second of a personal note, I had started the comment 
but didn't say much, just a word more. When I was growing up, 
my earliest recollections were my father, who was wounded in 
World War I in the Argonne Forest, carried shrapnel in his legs 
until the day he died. And I remember as a child the March on 
Washington in 1932. And my father was very sorry he couldn't go 
from Wichita, Kansas to that march. 

And when someone has a claim, they can ordinarily present it in 
court. And if you have medical testimony you can get to a jury, and 
a jury can decide the matters. That's not possible when the claim 
is against the United States government because of the doctrine of 
sovereign immunity. And we've gone through a similar line with 
Agent Orange and many, problems. But I think you have a fair 
representation of the sentiment of the Senate today, just by way 
of a backdrop, as we proceed now to the witnesses. 

And we first welcome Mr. John McLaughlin, who is the Vice 
Chairman for Estimate of the National Intelligence Council and the 
key officer on a matter like servicemen and service women's expo- 
sure to toxic materials. Mr. McLaughlin has a very distinguished 
record with the CIA, going back to 1972. He's served in most of the 
center in the world. And before turning to Mr. McLaughlin let me 
jaeld to our distinguished Vice Chairman. I know the Intelligence 
Committee had other commitments, and has just joined us. 

SSCI Vice Chairman KERREY. Thank you very much, Mr. Chair- 
man. 

I have a statement that I'd like to include in the record. But I 
want to express it in — I say it in my opening paragraph that we 
still have considerable amount of gratitude for — and great concern 
for the brave men and women who served in the Persian Gulf war 
and we owe a great debt to the soldiers who fought to liberate Ku- 
wait. 

Part of paying that debt, is that we should not let this victory 
translate into personal tragedy for anyone, any soldier who may be 
suffering from unique and unexplained sicknesses that were caused 
by their service. And I appreciate very much this joint hearing, and 
look forward to the testimony of the witnesses. 

SSCI Chairman Specter. Thank you very much, Senator Kerry. 

Welcome, Mr. McLaughlin. We would appreciate if you could 
summarize your written testimony. Your full statement will be 
made part of the record. We'd like to hold the opening rounds of 
questions to five minutes, leaving the maximum amount of time for 
dialogue, questions and answers with the panel. 

The floor is yours, Mr. McLaughlin. 

[The prepared statement of Mr. McLaughlin follows:] 



17 

Statement of John E. McLaughlin, Vice Chairman for Estimates, National 

Intelligence Council 

Chairman Specter, Chairman Simpson, and other Members of the Committees, I 
am pleased to appear before you this morning to discuss our ongoing efforts related 
to reports of possible exposure of our troops to chemical or biological agents in the 
Persian Gulf. Our Director strongly supports CIA's work on this important issue 
and continues to encourage us to bring forth important results of our study. Today 
I will provide CIA's key findings, background from our analysis on this issue, and 
a historical account of our assessments related to Gulf war illnesses. 

KEY FINDINGS 

On the basis of a comprehensive review of intelligence, we assess that Iraq did 
not use chemical or biological weapons or deploy these weapons in Kuwait. In addi- 
tion, analysis and computer modeling indicate chemical agents released by aerial 
bombing of chemical warfare facilities did not reach U.S. troops in Saudi Arabia. 
However, we have identified and will discuss potential fallout concerns in the case 
of a rear-area chemical weapons storage bunker in southern Iraq. 

CL\ ANALYSIS OF IRAQI CHEMICAL AND BIOLOGICAL WARFARE PROGRAM 

CIA has made a concerted effort to conduct a comprehensive review of intelligence 
related to Gulf war illnesses since March of last year. Our systematic review of in- 
telligence has been done in parallel with DOD's Persian Gulf Investigative Team. 
Our study is a detailed investigation into intelligence information — not troop testi- 
mony, medical records, or operational logs. The CIA's effort seeks to complement 
that of DOD. CIA analysts draw upon and examine DOD information to clarify in- 
telligence, to obtain leads, and to ensure a thorough and comprehensive intelligence 
assessment. CIA and the Investigative Team continue to coordinate our work. We 
inform the Investigative Team of relevant information on potential chemical or bio- 
logical exposures for follow-up. Likewise, the Investigative Team shares relevant re- 
siilts that aid our study. 

Our study involves two areas: research and focused investigations. We have re- 
viewed thousands of intelligence documents. Intelligence reports that relate to pos- 
sible chemical and biological weapons use, exposure, or location are scrutinized to 
determine their credibility and whether follow-up is warranted. In addition, we have 
expanded and more fully documented our assessments of Iraqi chemical and biologi- 
cal warfare capabilities at the start of Desert Storm. Using this research base, an 
investigation is then made into each of the key areas — use, exposure, and location — 
and specific areas are examined when possible leads are found. This was a nec- 
essary process to assure that our study is comprehensive. 

TIMELINE OF CL\ ACTIVITIES 

What follows is a chronological account of key events related to CW agent release. 
We have decided on this approach because of the complexity of the topic. 

CIA has long followed Iraq's chemical and biological programs as part of its mis- 
sion to assess CW and BW capabilities worldwide. Before the Gulf war, we assessed 
that Iraq had a significant CW and BW capability, including chemically armed 
Scuds, and had used chemical weapons on numerous occasions against Iran and its 
own citizens. At the start of the air war and continuing to the end of Desert Storm, 
the DI's Office of Scientific and Weapons Research established a 24-hour chemical 
and biological watch office. These analysts screened incoming intelligence for evi- 
dence of chemical or biological weapons use and followed every Scud launch. The 
CIA participated in targeting studies for CW and BW facilities that resulted in 
targeting of 32 separate sites. It is important to note that Khamisiyah was not iden- 
tified or targeted as a CW facility during the war. 

CHEMICAL FALLOUT FROM AERIAL BOMBING IN IRAQ 

Starting at the left of the chart you see that during the air war the Coalition 
bombed suspected CW sites. On the basis of all currently available information, we 
conclude that coalition aerial bombing resulted in damage to filled chemical muni- 
tions at two facilities — Muhammadiyat and Al Muthanna — both located in remote 
areas west of Baghdad. According to the most recent Iraqi declarations, less than 
5 percent of Iraq's approximately 700 metric tons of chemical agent stockpile was 
destroyed by coalition bombing. In most cases, the Iraqis did not store CW muni- 
tions in bunkers that they believed the Coalition would target. The Iraqis stored 
many of the CW munitions in the open to protect them from Coalition detection and 



18 

bombing. In addition, all known CW agent and precursor production lines were ei- 
ther inactive or had been dismantled by the start of the air campaign. 

Our modeling indicates that fallout from these facilities did not reach troops in 
Saudi Arabia. At Muhammadiyat Storage Area, Iraq declared that 200 mustard- 
filled and 12 sarin-filled aerial bombs were damaged or destroyed by Coalition 
bombing. Bombing of this facility started on 19 January and continued throughout 
the air war. Analysis of all available information leads us to conclude that the earli- 
est chemical munition destruction date at Muhammadiyat is 22 January. We have 
modeled release of 2.9 metric tons of sarin and 15 metric tons of mustard for all 
possible bombing dates. For these days, as for the whole time period of the bombing, 
southerly winds occur on only a few days. The board in front of you shows the maxi- 
mum downwind dispersions in the general southerly direction for sarin and mustard 
cut off at about 300 and 130 km respectively. Neither the first effects nor the gen- 
eral population limit levels reached U.S. troops that were stationed in Saudi Arabia. 

At Al Muthanna, the primary Iraqi CW production and storage facility, Iraq de- 
clared that 2,500 chemical rockets containing about 17 metric tons of sarin nerve 
agent had been destroyed by Coalition bombing. Analysis of all available informa- 
tion leads us to conclude that the earliest chemical munition destruction date is 6 
February. Of the days that the bunker at Muthanna could have been bombed, winds 
were southerly on only 8 February. For the general population limit dosage the most 
southerly dispersion on 8 February is 160 km, again well short of U.S. troops. 

CHEMICAL WEAPONS IN KUWAIT THEATER OF OPERATIONS 

Again referring to the timeline, on 4 March 1991 U.S. troops destroyed nerve 
agent-filled 122mm rockets in a Bunker at Khamisiyah. On 10 March 1991 they also 
destroyed CW rockets at a Pit area near Khamisiyah. The munitions were not 
marked, no acute injuries resulted and thus the troops and the CIA were unaware 
at the time that chemical munitions were destroyed. 

UNSCOM inspected chemical munitions at or near Khamisiyah in October 1991 
and identified 120mm sarin/cyclo-sarin (GB/GF) nerve agent-filled rockets and 
155mm mustard rounds. At the time it was not clear whether the chemical weapons 
identified had been present during the war or whether, as was suspected at other 
locations, the Iraqis had moved the munitions afi;er the war and just prior to the 
1991 UNSCOM inspection. This uncertainty was only cleared up through the recent 
comprehensive review of all intelligence information and an UNSCOM inspection in 
May 1996. The following information was obtained by UNSCOM during its October 
1991 inspection. 

At a pit area about 1 km south of the Khamisiyah Storage Area, UNSCOM found 
several hundred mostly intact 122mm rockets containing nerve agent — detected by 
sampling and with chemical agent monitors (CAMs). 

In an open area 5 km west of Khamisiyah; inspectors found approximately 6,000 
intact 155mm rounds containing mustard agent, as indicated by CAMs. 

At a third location, a single bunker among 100 bunkers, called "Bunker 73" by 
Iraq, remnants of 122mm rockets were identified. 

The Iraqis claimed during the October 1991 inspection that coalition troops had 
destroyed Bunker 73 earlier that year. These Iraqi statements were viewed at the 
time wdth skepticism because of the broad, continuous use of deception by the Iraqis 
against UNSCOM. 

During the 1992 to 1995 time frame, CIA's effort focused on identifjdng Iraq's re- 
sidual CW and BW stockpile. This effort consisted of assessing Iraq's declarations, 
refining collection requirements, and interpreting intelligence to attempt to root out 
remaining Iraqi CW capabilities. The issue of Gulf war illnesses surfaced to national 
prominence in about mid- 1993. CIA was not brought into this issue until March of 
1995. 

As mentioned earlier, we initiated a comprehensive review of all intelligence relat- 
ed to Gulf war illnesses in March of 1995. In September 1995, CIA identified 
Khamisiyah as another site for potential CW agent release and asked the DOD's 
Investigative Team to look into whether U.S. troops were there. We continued re- 
searching the issue together and by early March 1996, information was developed 
that enabled us to conclude that U.S. troops did blow up Bunker 73. However, we 
still had some uncertainty as to whether the rockets in the bunker were actually 
chemical. 

UNSCOM lacked specific documentation on the type of rockets in Bunker 73 cre- 
ating concerns for UNSCOM regarding chemical munitions accounting. These con- 
cerns about tjT)e of munition, especially given more recent UNSCOM understanding 
of the many varieties or rockets, motivated them to perform a new inspection at 
Khamisiyah. 



19 

UNSCOM's May 1996 investigation removed uncertainty about the type of muni- 
tions present in Bunker 73 because they documented the presence of high density 
polyethylene inserts, burster tubes, fill plugs, and other features characteristic of 
Iraqi chemical munitions. In addition, Iraq told the May 1996 UNSCOM inspectors 
that Iraq moved 2,160 unmarked 122mm nerve agent rockets to Bunker 73 from the 
Al Muthanna CW site just before the start of the air war. According to Iraq, during 
the air war they moved about 1,100 rockets from the bunker to the pit area 2 km 
away. 

MODELING OF RELEASE OF AGENTS FROM BUNKER 73 AT KHAMISIYAH 

Modeling of the potential hazard caused by destruction of Bunker 73 indicates 
that an area around the bunker at least 2 km in all directions and km downwind 
could have been contaminated at or above the level for causing acute symptoms in- 
cluding runny nose, headache, and miosis as you see in this figure. An area up to 
25 km downwind could have been contaminated at the much lower general popu- 
lation dosage limit. ^ Based on wind models and observations of a video and photo- 
graphs of destruction activity at Khamisiyah, we determined that the downwind di- 
rection was northeast to east. 

Some of the modeling assumptions we used were based on data from US testing 
in 1966 that involved destruction of several bunkers filled with GB rockets of simi- 
lar maximum range to Iraqi rockets found in Bunker 73. 

MUSTARD ROUNDS NEAR KHAMISIYAH 

During the May 1996 inspection, Iraq also told UNSCOM that the 6,000 155mm 
mustard rounds UNSCOM found in the open area at Khamisiyah in October 1991 
had been stored at one bunker at An Nasiriyah until 15 February 1991, just before 
the ground war. Iraq claims that fear of Coalition bombing motivated An Nasiriyah 
depot personnel to move the intact mustard rounds to the open area 5 km from the 
Khamisiyah Depot, where the rounds were camouflaged with canvas. Subsequently, 
we have been able to confirm that the munitions were moved to this area about this 
time. Therefore, based on the inspection and confirmation we conclude that the 
bombing of An Nasiriyah on 17 January 1991 did not result in the release of chemi- 
cal agent. 

ONGOING ANALYSIS OF PT ROCKET DESTRUCTION 

Iraq told UNSCOM in May 1996 that they believed occupying coalition forces also 
destroyed some pit area rockets. DOD's investigation into this possibility has indi- 
cated that US soldiers destroyed stacks of crated munitions in the pit on 10 March 
1991. From analysis of all information, we assess that up to 550 rockets could have 
been destroyed. Modeling of weather conditions indicate that the wind was almost 
due south. We are now modeling the actual hazard area and plan to finish our anal- 
ysis on the pit in the near future. 

CLOSING STATEMENT 

We will continue to be vigilant in tracking any lead that surfaces in the future. 
If we find any information pointing to chemical or biological agent exposures or im- 
pacting significantly on the issue of Gulf War veterans' illnesses, we will again work 
with the Department of Defense to announce those findings. 

STATEMENT OF JOHN McLAUGHLIN, VICE CHAIRMAN FOR 
ESTIMATES NATIONAL INTELLIGENCE COUNCIL 

Mr. McLaughlin. Chairman Specter, Chairman Simpson, and 
other Members of the Committees, I'm pleased to appear before you 
this morning to discuss our ongoing efforts related to reports of 
possible exposure of our troops to chemical and biological agents. 

Veterans' Chairman SiMPSON. If you could pull that over, please, 
towards yourself. 



' This dosage from Army manuals is for protection of the general population and is a 72 hour 
exposure at 0.000003 mg/m3 — significantly lower than the 0.000 lmg/m3 occupational limit de- 
fined for 8 hours. 



20 

Mr. McLaughlin. I'm pleased to appear before you to discuss 
this issue. Our director strongly supports the CIA's work on this 
important issue and continues to encourage us to bring forth im- 
portant results of our study. I can assure you we have a strong 
force of analysts who are working nearly around the clock on this 
issue and we will bring our findings to your attention as soon as 
we can. 

Today, I'm going to provide CIA's key findings, background from 
our analysis on this issue, and a historical account of our assess- 
ments related to Gulf War illnesses. 

Let me preview the key findings. On the basis of a comprehen- 
sive review of intelligence, we assessed that Iraq did not use chemi- 
cal or biological weapons or deploy these weapons in Kuwait. In ad- 
dition, analysis and computer modeling indicate that chemical 
agents released by aerial bombing of chemical warfare facilities did 
not reach U.S. troops in Saudi Arabia. However, we have identified 
and will discuss potential fallout concerns in the case of a rear area 
chemical weapons storage bunkers in southern Iraq. 

Let me now discuss our analysis of Iraqi chemical and biological 
warfare program. We've made a concerted effort to conduct a com- 
prehensive review of intelligence related to Gulf War illnesses since 
March of last year. Our systematic review of intelligence has been 
done in parallel with DOD's Persian Gulf investigation team. Our 
study is a detailed investigation into intelligence information, not 
troop testimony, medical records or operational logs. Our effort 
seeks to complement that of DOD. CIA analysts draw upon and ex- 
amine DOD information to clarify intelligence, obtain leads, and to 
ensure thorough and comprehensive intelligence assessments. 

CIA and the investigative team continue to coordinate our work 
and we inform the investigative team of relevant information as it 
arises. Likewise, they keep us informed. 

Our study involves two areas: research and focused investiga- 
tions. We've reviewed thousands of intelligence documents. Intel- 
ligence reports that relate to possible chemical and biological weap- 
ons use, exposure or location are scrutinized to determine their 
credibility and whether follow-up is warranted. In addition, we've 
expanded and more fully documented our assessments of Iraqi 
chemical and biological warfare capabilities at the start of Desert 
Storm. 

Using this research base, an investigation is then made into each 
of the key areas: use, exposure and location. And specific areas are 
examined where possible leads are found. 

Now let's take a look at a time line of CIA activities on this 
issue. What follows is a chronological account of key events related 
to CW agent release. We've decided on this approach because of the 
sheer complexity of this topic. 

CIA has long followed Iraq's chemical and biological programs as 
part of its mission to assess CW and BW capabilities worldwide. 
Before the Gulf War, we assessed that Iraq had a significant CW 
and BW capability, including chemically armed SCUDS, and had 
used chemical weapons on numerous occasions against Iran and 
against its own citizens. 

At the start of the air war and continuing to the end of Desert 
Storm, our analysts established a 24-hour chemical and biological 



21 

watch office. These analysts screened all of the incoming intel- 
ligence for evidence of chemical or biological weapons use. And they 
followed every SCUD launch. We participated in targeting studies 
for CW and BW facilities that resulted in targeting of 32 separate 
sites. It's important to note, that Khamisiyah was not identified or 
targeted as a CW facility during the war. 

Focusing now on chemical fallout from aerial bombing in Iraq. 
Starting at the left of the chart, you see that during the air war 
the coalition bombed suspected CW sites. On the basis of all cur- 
rently available information, we conclude that coalition aerial 
bombing resulted in damage to filled chemical munitions at two fa- 
cilities: Muhammadiyat and Al Muthanna, both located in remote 
areas west of Baghdad. According to the most recent Iraqi declara- 
tions, less than five percent of Iraq's approximately 700 metric tons 
of chemical agent, was destroyed by coalition bombing. In most 
cases the Iraqis did not store CW munitions in bunkers that they 
believed the coalition would target. The Iraqis stored many of the 
CW munitions in the open to protect them from coalition detection 
and bombing. 

In addition, all known CW agent and precursor production lines 
were either inactive or had been dismantled by the start of the air 
campaign. Our modeling indicates that fallout from these facilities 
did not reach troops — these facilities to the west of Baghdad, did 
not reach troops in Saudi Arabia. At Muhammadiyat storage area, 
Iraq declared that 200 mustard-filled and 12 sarin-filled aerial 
bombs were damaged or destroyed by coalition bombing. 

Bombing of this facility started on 19 January and continued 
throughout the air war. Analysis of all available information leads 
us to conclude that the earliest chemical munition destruction data 
at Muhammadiyat is 22 January. We have modeled release of 2.9 
metric tons of sarin and 15 metric tons of mustard for all possible 
bombing dates. 

SSCI Chairman SPECTER. Mr. McLaughlin, you're right in the 
middle of an important point, take a little more time. 

Mr. McLaughlin. OK. Let me — let me try and summarize this 
testimony, rather than giving it to you word for word. Essentially, 
when we looked at that bombing in northern Iraq, we modeled the 
results of the coalition bombing, and the board over here will show 
you that we think the maximum downwind dispersions in a general 
southerly direction for sarin and mustard cut off at about 300 and 
130 kilometers, respectively. Neither the first effects nor the gen- 
eral population limit levels reached U.S. troops that were stationed 
in Saudi Arabia. 

At Al Muthanna, we did a similar modeling and we determined 
that the winds were southerly on only 8 February. For the general 
population limit dosage, the most southerly dispersion on 8 Feb- 
ruary is about 160 kilometers — again, well short of U.S. troops. 

Now let me turn to the question of chemical weapons in the Ku- 
wait theater of operations. Again, looking at this timeline, on 4 
March, U.S. troops destroyed nerve agent-filled 122-millimeter 
rockets in a bunker at Kamisiyah. On 10 March, 1991, they also 
destroyed CW rockets at a pit near Kamisiyah. The munitions were 
not marked. No acute injuries resulted and thus the troops and the 



22 

CIA were unaware at the time that chemical munitions were de- 
stroyed. 

UNSCOM inspected chemical munitions at or near Kamisiyah in 
October of 1991, and identified 120-millimeter sarin/cyclo-sarin 
nerve agent-filled rockets and 155-millimeter mustard rounds. At 
the time, it wasn't clear whether the chemical weapons identified 
had been present during the war or whether, as was suspected at 
other locations, the Iraqis had moved the munitions after the war 
and just prior to the 1991 UNSCOM inspection. This was only 
cleared up — this uncertainty — with a comprehensive review of all 
intelligence, and an UNSCOM inspection in May 1996. 

The following information — let me just summarize what the 
UNSCOM found in 1991. At a pit area about a kilometer south of 
the Kamisiysih storage area, UNSCOM found several hundred 
mostly intact 122-millimeter rockets containing nerve agent. In an 
open area about five kilometers west of Kamisiyah, inspectors 
found about 6,000 intact 150-millimeter rounds containing mustard 
agent as indicated by tests on the scene. At a third location, a sin- 
gle bunker among 100 bunkers called Bunker 33 by Iraq, remnants 
of 122-millimeter rockets were identified. The Iraqis claimed dur- 
ing the October '91 inspection that coalition troops had destroyed 
Bunker 33 earlier that year. These Iraqi statements were viewed 
at the time with skepticism — and Bunker 73 — these statements 
were viewed with skepticism because of the broad continuous use 
of deception by the Iraqis against UNSCOM. 

During the 1992 and '95 time frame, CIA's effort focused on iden- 
tifying Iraq's residual CW and BW stockpile. This effort consisted 
of assessing Iraq's declarations, refining collection requirements, 
interpreting intelligence to attempt to root out remaining Iraqi CW 
capabilities. The issue of Gulf War illnesses surfaced to national 
prominence, as you know, in about mid-'93. CIA did not begin its 
independent review of this issue until March of '95. 

As mentioned earlier, we initiated a comprehensive review of all 
intelligence at that time. In September of '95, we identified 
Kamisiyah as another site for potential CW agent release, and 
asked the DOD's investigative team to look into whether U.S. 
troops were there. We continued researching the issue together 
and, by early March '96, information was developed that enabled 
us to conclude U.S. troops did blow up Bunker 73. 

We still had some uncertainty, however, about whether the rock- 
ets in the bunker were actually chemical. UNSCOM lacked specific 
documentation on the type of rockets in that bunker, creating con- 
cerns for UNSCOM regarding chemical munitions accounting. 
These concerns about type of munition, especially given more re- 
cent UNSCOM understanding of the many varieties of rockets, mo- 
tivated them to perform a new inspection at Kamisiyah. They did 
this in May 1996. That removed uncertainty about the type of mu- 
nitions present in Bunker 73 because of the various things they 
found: high density polyethylene inserts, burster tubes, fill plugs, 
other things that are associated with Iraqi chemical munitions. 

In addition, Iraq told the May 1996 UNSCOM inspectors that 
Iraq moved over 2100 unmarked 122-millimeter nerve agent rock- 
ets to Bunker 73 from the Al Muthanna site in northern Iraq just 
before the start of the war. According to Iraq, during the air war, 



23 

they moved about 1100 rockets from the bunker to the pit area two 
kilometers away. 

Now, let me tell you what we found when we modeled the release 
of agents at Bunker 73. Modeling of this potential hazard at Bunk- 
er 73 indicates that an area around the bunker, at least two kilo- 
meters in all directions and four kilometers downwind, could have 
been contaminated at or above the level for causing acute symp- 
toms including runny nose, headache, miosis as you see in this fig- 
ure. An area up to 25 kilometers downwind could have been con- 
taminated at the much lower general population dosage limit. 
Based on wind models, and observations of a video, and photo- 
graphs of destruction activity at Kamisiyah, we determined that 
the downwind direction was northeast to east. 

Some of the modeling assumptions we used were based on data 
from U.S. testing in 1966 in bunkers filled with similar rockets of 
U.S. manufacture. 

Now, let me talk about the mustard rounds found near 
Kamisiyah. During this May 1996 

SSCI Chairman Specter. Mr. McLaughlin, would you do your 
best to summarize? 

Mr. McLaughlin. All right, let me move on to the pit rocket de- 
struction. 

Iraq told UNSCOM in May '96 that they believed occupying coa- 
lition forces also destroyed some rockets in a pit area near this 
bunker. DOD's investigation into this possibility has indicated that 
U.S. soldiers destroyed stacks of crate munitions in the pit on 10 
March 1991. From analysis of all information, we assess that about 
550 rockets could have been destroyed. Modeling of weather condi- 
tions indicate the wind was almost due south. We are now model- 
ling the actual hazard area and plan to finish our analysis on the 
pit in the near future. Let me just say we're working this very 
hard, nearly around the clock, and we'll report the results of this 
modelling to you as soon as it's feasible. 

In sum, I would just say you can count on us to be continuously 
vigilant in tracking any lead that surfaces in the future on this. We 
share the concerns you've expressed, and we will work it and report 
our findings to you as soon as we can. 

SSCI Chairman Specter. Thank you very much, Mr. 
McLaughlin. 

We now turn to Dr. Steven C. Joseph, who is the chief Depart- 
ment of Defense health officer in his capacity as Assistant Sec- 
retary of Defense for Health Affairs. Dr. Joseph has a very distin- 
guished academic and professional record, graduating from Har- 
vard College, Yale University School of Medicine, and Johns Hop- 
kins, where he has a masters in Public Health. He was dean at the 
school of public health at the University of Minnesota, and has 
served as commissioner of health for New York City. 

Welcome, Dr. Joseph, and the floor is yours. 

Dr. Joseph. Mr. Chairman, distinguished Members of the Com- 
mittee, I thank you for this opportunity to present a current as- 
sessment of the Kamisiyah incidents, other reports of detection and 
the initiatives under way for our Persian Gulf veterans. 

With your permission, I'd ask that my complete statement 



24 

SSCI Chairman SPECTER. Your full statement will be made part 
of the record and to the extent you can summarize within the five 
minute limit, the Committee would appreciate it — Committees 
would appreciate it. 

[The prepared statement of Dr. Joseph follows:! 

Statement of Stephen C. Joseph, M.D., M.P.H., Assistant Secretary of 
Defense for Health Affairs 

Khamisiyah represents a major change in our understanding of the health issues 
and potential exposures of our troops during and following Operations Desert Shield 
and Desert Storm. This change has required us to re-examine our responses to Per- 
sian Gulf Illnesses, and to expand our unprecedented, existing clinical, investigative, 
declassification and research programs. In light of Khamisiyah, there are seven spe- 
cific initiatives the Department of Defense is undertaking. These initiatives are: 

a. Using our own capabilities and those of the CIA, we are modeling and inves- 
tigating all aspects of the bunker 73 demolition, the Khamisiyah pit destruction, the 
24 Fox vehicle and M256 positive detections, and the two Czech detections. 

b. At the direction of the Deputy Secretary, the Army Inspector General will track 
the chronology of the Khamisiyah incidents. 

c. Also at the direction of the Deputy Secretary, the Assistant to the Secretary 
of Defense for Intelligence Oversight, Walter Jaiko, will compile a chronology of 
events related to the Khamisiyah incidents and the information concerning those in- 
cidents. 

d. We are undertaking an expansion of our clinical investigations of those troops 
known to have been in potential "exposure zones." 

e. We have asked the Institute of Medicine, and they have agreed, to have their 
Committee on the Persian Gulf Syndrome Comprehensive Clinical Evaluation Pro- 
gram (CCEP) re-assess our CCEP clinical protocols in light of plausible incidents of 
exposure to chemical warfare agents. 

f. We have expanded our program of research to include projects examining pos- 
sible clinical effects of low level exposure to chemical warfare agents. 

g. We have asked the Interagency Security Classification Appeals Panel to under- 
take an objective review of the documents placed on GulfLINK and to make rec- 
ommendations regarding declassification of documents and their posting on the 
Internet. 

Khamisiyah has changed the paradigm of our approach to Persian Gulf Illnesses. 
Previously, we had a number of Gulf War veterans who were ill and we sought ex- 
planations for those illnesses. Now, we have evidence of possible chemical warfare 
agent exposures. It is imperative that we now attempt to find clinical evidence that 
might be linked to those exposures in our troops who were in the "exposure zones." 

The Department, while dedicating its energies to the programs addressing Persian 
Gulf Illnesses and working to re-orient and expand those programs based on the 
Khamisiyah information, still must look to the future. The Department has initiated 
a medical surveillance program for all deployments which significantly improves the 
health screenings prior to and following deployment and requires enhanced preven- 
tive medicine and environmental monitoring activities throughout the deployment. 
We will know the health status of our forces and we will have detailed documenta- 
tion of potential exposures. 

STATEMENT OF DR. STEPHEN JOSEPH, ASSISTANT SEC- 
RETARY FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE 

Dr. Joseph. President Clinton promised that we would explore 
all avenues of potential cause for illnesses, that we would take care 
of the veterans who believe their Gulf War experience has resulted 
in a degradation of their health, and that this Administration 
would put its resources into scientific research to find explanations 
for these illnesses. 

My comments today will address first the most current informa- 
tion we have on the demolition of Bunker 73 and the destruction 
of weapons in the pit at Kamisiyah, as well as other reports of de- 
tections. Then I will describe the actions DOD has taken as a re- 
sult of this information. Finally, if you permit me with time, I'll 



25 

outline the programs the Department has taken to fulfill the Presi- 
dent's commitment to care for our Persian Gulf veterans. 

Kamisiyah's ammunition storage area, also known as Tel-Alam 
in southern Iraq, was a large ammunition storage depot before and 
during Operations Desert Shield and Desert Storm. The Kamisiyah 
facility contained nearly 100 ammunition storage bunkers, covered 
a 25 square kilometer area. 

Prior to the Gulf War, the intelligence community did not list 
Kamisiyah itself as a suspect chemical weapons site. As a result, 
it was not targeted as a chemical facility for coalition bombing. It 
was not until October 1991, some eight months after the end of 
Desert Storm that information was identified suggesting the facil- 
ity did store chemical weapons during Desert Storm. 

As you've heard, an UNSCOM team inspected the Kamisiyah 
ammunition area in October '91 and I will not repeat the detail 
from Mr. McLaughlin's testimony about the numbers of the muni- 
tions. UNSCOM inspectors found several hundred 122-millimeter 
rockets with a mixture of the chemical nerve agents sarin and 
cyclo-sarin. These munitions were found in several heaps or piles 
in a large pit or revetment. Most of these rockets were intact but 
some appeared to be damaged or destroyed. 

At that time the Iraqis told UNSCOM that occupying coalition 
troops had destroyed chemical weapons at Bunker 73 earlier that 
year, that is in '91. Iraqi statements, however, were viewed with 
skepticism at the time because of the broad continuous use of de- 
ception by the Iraqis against UNSCOM. And UNSCOM tests for 
the presence of chemical agents at Bunker 73 were negative. 

In March of '92 UNSCOM inspectors returned to Kamisiyah. 
There they reported that they consolidated and destroyed a total of 
463 nerve agent rockets found in the pit area, including the 297 
they had found previously in October. 

In May of 1996, UNSCOM inspectors returned to Kamisiyah, and 
for the first time did a thorough evaluation of remanants at Bunk- 
er 73. They found that the rockets still remaining in and near 
Bunker 73 possessed the physical characteristics of 122-millimeter 
chemical rockets used by the Iraqis, and were the same t5TDe which 
had been found in the pit area. It was at this time that Iraqi offi- 
cials told UNSCOM for the first time that occupying coalition 
forces had destroyed the rockets found in the pit area. 

Now, back in early March of '91, after the Gulf War cease fire, 
the 37th engineering battalion, as well as elements of the 307th en- 
gineer battalion, both supporting the 82nd Airborne Division, 
moved into the vicinity of Kamisiyah with a mission to destroy the 
bunkers and their contents, prior to moving back to Saudi Arabia 
for redeployment. During the period three to ten March '91, a sys- 
tematic destruction of the Kamisiyah bunkers was conducted. Ex- 
plosive ordinance disposal unit personnel supported the engineers 
during this operation. All EOD members who'd been interviewed 
stated that they were aware that they might encounter chemical 
munitions at any ammunition site and were looking for them. At 
Kamisiyah, they reportedly examined each bunker and did not 
identify any chemical munitions. 

Operational records, intelligence information and personal inter- 
views with over 40 individuals involved in the operation, including 



26 

the battalion commander, three company commanders, has enabled 
a reconstruction of the events which occurred at Kamisiyah be- 
tween 2 to 10 March 1991. Elements of the 37th engineer battalion 
moved into Kamisiyah area on March 2. And on March 4th, the en- 
gineers destroyed 33 bunkers, one of which was Bunker 73, now 
identified as containing chemical munitions in May of 1996 by 
UNSCOM. 

I describe the process in my prepared testimony in detail in 
terms of what was blown when and what was found in the various 
bunkers. 

The 37th Engineering Battalion operations officer stated that on 
9 March, he found an unknown number of stacks of long-crated 
munitions in the pit area as distinct from Bunker 73, which cor- 
responds to the location where UNSCOM teams found the damaged 
122-millimeter rockets. And those pit area stacks of munitions 
were destroyed on the 10th of March. I won't repeat, but I'd be 
happy to talk in the question period, Mr. McLaughlin's comments 
about the current CIA modeling which is going on, and what, in- 
deed, they have found in their model for the Bunker 73 area and 
what they will come up with in the pit area. 

The 4,000 to 5,000 potentially affected troops within 25 kilo- 
meters of the Bunker 73 detonation of March 4th are being notified 
and advised of the availability of the DOD and VA evaluation 
treatment program. 

Using our geographic information system, we've identified unit 
locations near Kamisiyah on 10 March — that's the date that the pit 
was blown— 1991. The 3,000 to 4,000 potentially affected troops 
within 25 kilometers of the pit destruction on March 10th are also 
being notified and advised of our evaluation and treatment pro- 
grams. 

There were no chemical casualties reported during the demoli- 
tion operations of either area. An evaluation of medical logs of the 
units in the area did not show any increase in clinic visits or any 
reports of possible chemical exposure symptoms. 

In our evaluation of the reported chemical detections from the 
NBC reconnaissance vehicle, the FOX vehicle, and the M256 kits, 
we looked for any reports of symptoms of acute exposures to chemi- 
cal agents or reports of chemical casualties among the units in the 
vicinity of the reported detections — that is, not only at Kamisiyah, 
but all other sites during and after the war where FOX vehicle or 
M256 alarms went off. 

Except for the incident of the blister agent exposure of Sergeant 
David Fisher, an Army scout who went into a bunker in southern 
Iraq during the war, we found none. 

We then looked for any physical evidence that might indicate 
that chemical agent were present in the area of the detections. 
Again, we have found no evidence that would allow us to assess the 
validity of any of the reported detections. That is not to say that 
the detections are not valid, but simply that we have not been able 
to find corroborating evidence such as physical samples. 

Since during the war there were no reported chemical casualities 
or symptoms of acute exposure apart from the Sergeant Fisher inci- 
dent, and no physical evidence to substantiate that chemical agents 
were present, we then turned our attention to the question of 



27 

whether there might have been low — below detector-sensitivity — 
levels of chemical agents present. 

To date, we have not been able to identify human or animal stud- 
ies that have directly addressed the issue of short-term low-level 
nerve agent exposure followed by chronic symptoms or disease. The 
existing literature consistently indicated that in humans and ani- 
mals receiving short-term exposure to agent levels which do not 
produce symptoms acutely, no long-term clinical effects are found. 

Once learning of the probable presence of chemical agents at 
Kamisiyah, we initiated several steps concurrently to rapidly as- 
sess whether health-related consequence may have occurred among 
service members who demolished the bunker. With those steps un- 
derway, we expanded the geographic ring from the immediate vi- 
cinity of the bunker to a surrounding distance of five kilometers 
and then to 25 kilometers. 

During this period, further information came to light indicating 
the detonation of chemical weapons in the pit at the Kamisiyah 
storage site. We initiated the same steps for the pit that were un- 
derway for the bunker. However, because of the nature of the deto- 
nation and the larger amount of munitions at the pit site, we are 
considering geographic rings of greater distances. 

These are the steps, medically, that we've taken and that con- 
tinue to be taken today. The demolition of the bunker itself — Bunk- 
er 73 — involved approximately 150 individuals at that site. Our 
first step was to review the clinical records of service members 
from these involved units, who also had participated in the depart- 
ment's comprehensive clinical evaluation program. 

We've now signficantly broadened our review efforts to include 
all members of the four units who were at Kamisiyah, plus others 
known to have been in the geographic rings of five and 25 kilo- 
meters of the bunker at the time of demolition. Similar reviews of 
clinical records of involved service members are underway for those 
who were within geographic rings surrounding the Kamisiyah pit. 
And when we receive the modeling of the pit exposure zone from 
the CIA, we will set those rings appropriately. 

The second step was to contact individuals who were assigned to 
these units personally to inform them of the details we knew thus 
far, to obtain any other information regarding Kamisiyah that they 
may recall and to remind them of the availability of medical eval- 
uations through the VA or DOD. This investigative efforts contin- 
ues and thus far over 400 individuals have been contacted by tele- 
phone. 

Next, we are conducting a review of information regarding DOD 
hospitalizations since the Persian Gulf War accumulated by the 
Naval Health Research Center to identify any unusual patterns in- 
volving members of those units. Our preliminary results from the 
first review reveal that there are no unusual hospitalizations. 

Our next step was to conduct preliminary investigations of other 
sites where there may have been the potential for exposure of U.S. 
forces to chemical agents. Mr. McLaughlin has already spoken 
about the two sites destroyed from the air. We are now examining 
the reports of positive indicators from the FOX detection vehicles, 
the M-256's and the two Czech detections. These incidents number 



28 

26 in all, including 12 Fox detections, and 12 M-256 detections, 
and including the report from Al Jubayl. 

We have established as a top priority and are funding as quickly 
as possible expedited peer review research concerning the subject 
of potential chronic effects caused from low-level exposures to 
chemical agents. We've already funded three research proposals for 
$2.5 million, and we're committed to funding another $2.5 million 
in the next months. 

Finally, we have asked the Institute of Medicine, which oversaw 
our initial CCEP — Clinical Evaluation Program — to re-examine 
their review of our program to determine if, in the light of the 
Kamisiyah information, we should again evaluate these individuals 
or to conduct further tests — whether we should alter our protocol. 

Mr. Chairman, I don't know whether you want me to take more 
time going back through the steps that we had taken before 
Kamisiyah. I have some very strong feelings about some of the 
comments that have been made about our clinical evaluation pro- 
gram, which began in May of 1994. We've extensively examined 
and cared for over 22,000 individuals, and that registry is on-going. 
But I will respond to your questions on that, perhaps, rather than 
take more time in my prepared statement. 

Similarly, you will find in my prepared statement details on the 
department's senior oversight panel, the Persian Gulf investigation 
team formed in '94, our extensive declassification effort and the re- 
search portfolio of activities that we are conducting ourselves and 
in collaboration with the Veterans' Administration. 

I also would leave for you to see in the prepared testimony how 
some of the lessons learned from this experience in the Gulf are 
now being built into our activities in other deployments, including 
Bosnia, so that we have a more effective pre- and post-deployment 
surveillance mechanism. 

SSCI Chairman Specter. Thank 

Dr. Joseph. Mr. Chairman, I'll close, if I may. May I finish my 
closing statement? 

SSCI Chairman Specter [continuing]. Thank you. Dr. Joseph. 
Your full statement and the addenda will be included in the record 
and I did not want to interrupt your testimony because there is a 
lot of explaining to do and I wanted to give you a full opportunity 
to do that. And you'll have further opportunity, I'm sure. There'll 
be some questions. 

We now turn to Dr. Kenneth W. Kizer, who is the Under Sec- 
retary for Health of the Department of Veteran's Affairs, a very 
distinguished academic and professional record; honors graduate of 
Stanford University and the University of California; certified in 
five medical specialities; author of some 300 articles, books, chap- 
ters or other reports; extensive service in government, academia, 
philanthropy; served for six years as director of the California De- 
partment of Health Service. 

The floor in yours. Dr. Kizer. To the extent that you can limit 
your opening comments to five minutes, we'd appreciate it. Time is 
going. We have quite a few Senators who want to question. 

[The prepared statement of Mr. Kizer follows:] 



29 

Statement of Kenneth W. Kizer, M.D., M.P.H., Under Secretary for Health, 
Department of Veterans Affairs 

Mr. Chairman and Members of the Committees, I appear before you today to up- 
date you on the Department of Veterans Affairs (VA) Persian Gulf War-related pro- 
grams, with a specific focus on VA responses to the possibility, and now probability, 
of low-level exposure of American troops to chemical warfare nerve agents. 

In the way of background let me reiterate a few points about VA's general re- 
sponse. 

Shortly after returning from the Persian Gulf conflict in 1991, veterans began to 
report a variety of s3Tnptoms and illnesses. In response, the Department of Veterans 
Affairs developed the first of its several programs for these veterans. This was the 
Persian Gulf Veterans Registry health examination program. Ever since then, the 
Department has continuously tried to improve and expand its Persian Gulf War-re- 
lated programs. Those programs now encompass a four-pronged approach that in- 
cludes medical care, research, compensation, and outreach. 

With regard to medical care, I would noted that VA provides Persian Gulf Reg- 
istry Health Examinations, Referral Center evaluations, and readjustment and sex- 
ual trauma counseling, as well as outpatient and inpatient care under special eligi- 
bility provisions for Persian Gulf War veterans. 

VA's position since the Registry's inception has been that all Persian Gulf War 
veterans should participate in the Registry program. To date, more than 60,000 vet- 
erans have completed Registry examinations. Almost 187,000 have been seen in VA 
ambulatory care clinics, and more than 18,200 have been hospitalized at VA medical 
facilities. 

Persian Gulf veterans participating in the Registry examination have commonly 
reported a diverse array of symptoms, including fatigue, headache, muscle and joint 
pain, memory problems, shortness of breath, sleep disturbances, nausea, diarrhea 
and other gastrointestinal complaints, rashes, and chest pain. Of note, 12 percent 
of the Registry examinees have no health complaints but wish to participate in the 
examination to establish a baseline should they develop future health problems that 
might later be found to be due to their service in the Persian Gulf War. 

I would reiterate again today that VA encourages all Persian Gulf War veterans, 
whether symptomatic or not, to avail themselves of the Registry examination pro- 
gram, especially if they are concerned about possible exposure to chemical warfare 
agents in light of DoD's recent announcements. Further, we would encourage per- 
sons who have been previously examined as part of the Registry program to request 
a follow up examination if they have sjTnptoms or concerns. 

VA has always remained open to the possibility that military personnel may have 
been exposed to a variety of hazardous agents, including chemical warfare agents, 
while serving in the Gulf War theater of operations. 

In this regard, some Members of Congress have recently asked VA whether we 
listened to veterans who reported their belief that they had been exposed to chemi- 
cal warfare agents during their Persian Gulf service. We did listen to those veter- 
ans. Illustrative of this, prior to the DoD announcement on June 21, 1996, VA de- 
signed its clinical uniform case assessment protocol to detect clinical signs and 
symptoms related to possible neurotoxic exposures. Neurologic examinations and 
cognitive testing have been part of the protocol from early on. As a result of this, 
VA diagnostic protocols and treatment programs do not need any substantial revi- 
sion in light of DoD's recent disclosures about the release of sarin at Khamisiyah 
in March 1991. 

Likewise, in response to a Reserve Construction Battalion unit of PGW veterans 
from Alabama, Tennessee, North Carolina, and Georgia reporting adverse health ef- 
fects, which they believed were due to exposure to low-level chemical warfare 
agents, VA established a pilot medical assessment program at the Birmingham VA 
Medical Center to evaluate their health status. (As part of this special health care 
program, more than 100 veterans were evaluated. Included in this group were 55 
veterans who complained of cognitive problems; these veterans underwent extensive 
(7-8 hours) neuropsychological testing and clinical evaluations. These evaluations 
did not reveal the pattern of neurologic abnormalities typically associated with 
neurotoxin exposure.) This pilot program evolved into VAMC Birmingham being 
designated a special referral center in June 1995. 

A further demonstration of the fact that we were heeding what the veterans were 
sajang can be found in the National Health Survey of Persian Gulf War Veterans 
where specific questions are asked about possible exposure to chemical warfare 
nerve toxins and mustard gas. 

At this juncture, I believe it is very important to point out that there is no bio- 
marker, laboratory finding or diagnostic test for chemical warfare agent nerve toxin 



40-180 97-2 



30 

exposure. The diagnosis of conditions related to nerve toxins, whether they be chem- 
ical warfare agents, pesticides or hazardous industrial chemicals, is based on two 
things: first, known or presumed exposure to the chemical agent, and second, symp- 
toms or physical signs consistent with the known biological effects of the chemical. 
Absent aefinite exposure data and/or typical symptoms and signs, it is essentially 
impossible to make a definitive diagnosis of chemical-related neurotoxicity. Further- 
more, there is no curative therapy for the expected neurotoxic effects of these 
agents, although symptomatic treatments are available and represent the state-of- 
the-art at this time. 

These same problems apply to conducting research in this area. Indeed one of the 
most challenging problems in conceptualizing and designing valid scientific studies 
of potential long-term effects of low level exposure to chemical warfare agents is 
knowing wjhat exactly one should measure and study when there were no symptoms 
or signs of acute toxicity. It is clear in my mind that if we are going to adequately 
research these questions a major investment will be needed to develop both the 
physical plant capabilities and the intellectual capital that are required to conduct 
these very difficult studies. 

The results of our Persian Gulf Registry health examination program are similar 
to those reported by other investigators, including scientists in England and Can- 
ada. In reviewing these data, it is important to recognize that numerous scientists 
and advisory committees have reviewed the medical data collected in these pro- 
grams and have concluded that a wide variety of illnesses, including the whole 
range of well-defined medical and psychiatric conditions, are being diagnosed among 
PGW veterans. Furthermore, VA physicians have found that only a relatively small 
percentage of PGW veterans have unexplained illnesses and that no single, unique 
disease explains the range of the illnesses being diagnosed in Persian Gulf War vet- 
erans. That is, there is no Gulf War Syndrome in the strict medical sense of the 
term. In saying this, though, it is important to emphasize that VA does not at all 
doubt that many veterans reporting unexplained illnesses are suffering from real ill- 
ness, and some are seriously ill, and that the inability to make definitive diagnoses 
is very frustrating for our physicians and other practitioners,as well as our veteran 
patients. 

We continue to search for answers, and we continue to strive to expand our under- 
standing of the illnesses of Persian Gulf veterans. And while scientific answers are 
being sought through research, VA will continue to provide needed healthcare and 
other services, including disability compensation, for those veterans suffering from 
either diagnosed or underdiagnosed illnesses. 

With regard to research, I would remind you that the Registry and other similar 
examination program data are provided through medical records of self-selected in- 
dividuals and, thus, may not be reflective of the entire population of Persian Gulf 
War veterans. In order to draw definitive conclusions about the health status of 
PGW veterans, a carefully designed and well-executed research program is nec- 
essary. VA has initiated such a research program. 

VA's research program related to Persian Gulf veterans illnesses includes more 
than 30 individual projects being carried out by VA and university-affiliated inves- 
tigators across the nation. And these projects are but part of the overall federal re- 
search effort. 

VA established three Environmental Hazards Research Centers in 1994; all three 
centers are carrying out projects which address aspects of the potential adverse 
health outcomes of exposure to neurotoxins. In addition, VA's Environmental Epide- 
miology Service has completed a Persian Gulf Veterans Mortality Study and the 
first phase of the National Health Survey of Persian Gulf War Veterans and their 
Families. Details of these and other Government Federally sponsored research stud- 
ies are included in the report, "Federally Sponsored Research on Persian Gulf Veter- 
ans Illnesses for 1995." Copies of this report have been provided to the Committees. 

In May, VA announced that it would establish a fourth Environmental Hazards 
Research Center. This center will study adverse reproductive health effects that 
may be associated with military occupational exposures in the Persian Gulf, Viet- 
nam and elsewhere. The proposals were due to VA's Research and Development 
Service on September 16, and awards will be made in the next two months. 

I would take this opportunity to also give you a status report on the progress of 
two major epidemiological efforts. 

The first is the Persian Gulf War Veterans Mortality Study. This study analyzes 
the specific causes of all deaths among the 696,562 Persian Gulf veterans who 
served in the theater of operations between August 1990 and April 1991, and a com- 
parison group of 746,291 veterans who served elsewhere. The follow-up period for 
this study went through September 1993. The Persian Gulf Veterans Mortality 
Study has been completed and has been accepted for publication in a major sci- 



31 

entific journal. While the study demonstrates an excess in deaths in PGW veterans 
due to external causes, such as automobile accidents, it does not demonstrate dif- 
ferences in death rates due to medical conditions, including deaths due to cancer. 
The results of this, and other scientific studies taken together, suggest that PGW 
veterans as a group are not suffering from life-threatening medical conditions at 
rates higher than veterans who did not serve in Operations Desert Shield and 
Desert Storm. 

The second study is the National Health Survey of Persian Gulf Veterans and 
their FamiUes. This is being carried out by the VA's Environmental Epidemiology 
Service. Phase 1, a postal survey of 15,000 Gulf War veterans and a comparison 
group of 15,000 Gulf era veterans, was completed in August. The questions on this 
survey asked veterans to report health complaints, medical conditions, and a wide 
variety of possible environmental exposures, including episodes of potential nerve 
gas, mustard gas, or biological warfare exposure. The response rate for Phase I of 
this survey was 57 percent. Phase II will consist of 8,000 telephone interviews and 
a review of 4,000 medical records. Phase II will address the potential for non-re- 
sponse bias, provide a more stable estimate of prevalence rates for various health 
outcomes, and verify self-reported health outcomes in medical records. The Phase 
III examination protocol is being finalized and examinations of veterans and their 
family members are expected to begin in Spring 1997. The protocol is being re- 
viewed to determine if revisions are indicated based on our new knowledge of poten- 
tial low-level chemical warfare agent exposures. Peer-review is being provided by a 
subcommittee of VA's Persian Gulf War Expert Scientific Advisory Committee. It is 
too early to discuss the results of this study as we have just begun our analysis of 
the Phase I results. 

In January 1994, the Secretaries of VA, DoD, and HHS established the Persian 
Gulf Veterans Coordinating Board to provide interdepartmental coordination and di- 
rection of federal programs related to Persian Gulf War veterans. The Coordinating 
Board provides an interdepartmental means to share information on Persian Gulf 
War veterans health, to effectively allocate available resources, and to provide 
means of disseminating new research information. The Coordinating Board has 
three primary objectives: 

To ensure that all veterans are provided the complete range of healthcare services 
necessary to take care of medical problems that may be related to deplo3Tnent in 
Operations Desert Shield and Desert Storm; 

To develop a research progreim that will result in the most accurate and complete 
understanding of the health problems experienced by PGW veterans and the factors 
that have contributed to these problems; and 

To develop clear and consistent guidelines for the evaluation and compensation 
of disabilities related to Persian Gulf service. 

VA plays a central role in the Persian Gulf Veterans Coordinating Board through 
its participation in the CUnical, Research, and Compensation and Benefits Working 
Groups. In particular, the research working group provides guidance and coordina- 
tion for VA, DoD and HHS research activities related to Persian Gulf War veterans 
health. It coordinates all studies conducted or sponsored by these departments to 
prevent unnecessary duplication and to ensure that important gaps in scientific 
knowledge are identified and addressed. The working group is actively involved in 
directing resources toward high priority questions and monitoring the results of 
Federally-sponsored research projects. It has produced two reports: the "Report of 
Federal Research Activities Related to Persian Gulf Veterans Illnesses" and the 
1995 document "A Working Plan for Research on Persian Gulf Veterans Illnesses." 
The 1996 update of the Working Plan was due to be released in September but will 
be delayed to allow incorporation of this new information. 

One example of the Coordinating Board's proactive role in relevant research ad- 
ministration was its prioritization of the federal government and non-government 
research proposals submitted for funding to DoD's Broad Agency Announcement. 
The American Institute for Biological Science (AIBS) performed peer-review of the 
111 proposals submitted. The research working group reviewed those proposals 
judged scientifically meritious by AIBS and prioritized them according to relevance 
and potential to fill research gaps in the existing Persian Gulf research portfolio. 
Twelve research projects encompassing the areas of reproductive outcomes, toxi- 
cology of pyridostigmine bromide, modeling of respiratory toxicant exposures from 
tent heaters, psychological outcomes, leishmaniasis, chronic fatigue, fibromyalgia, 
and neuromuscular function were given high priority for funding by the research 
working group. 

Important to note is the fact that studies of low-level chemical warfare agent ex- 
posure were not given priority in the 1995 Working Plan or other research questions 



32 

because military and intelligence sources had repeatedly stated that there had been 
no use, presence, or evidence of exposure to chemical warfare agents. Based on those 
repeated assertions, combined with a lack of clear cut clinical evidence to support 
a finding of chemical warfare exposure, the Coordinating Board focused its research 
resources on other questions. This decision was supported by the Institute of Medi- 
cine, VA Persian Gulf Expert Scientific Committee, the National Institutes of 
Health Technology Assessment Workshop, and others. 

When DoD made its recent announcement regarding possible exposure of U.S. 
troops to chemical warfare nerve agents at Khamisiyah the Coordinating Board im- 
mediately began revision of its action plan. 

VA, through the Research Working Group of the Coordinating Board, has devel- 
oped an action plan to address possible long-term health consequences of low-level 
exposure to chemical warfare toxins and mustard gas, based on the DOD's an- 
nouncements regarding the demolition of a chemical munitions bunker and the de- 
struction of a pit containing sarin and cyclosarin at Khamisiyah. 

A recent literature review carried out by the Armed Forces Epidemiology Board, 
an advisory board of independent, non-government scientists, suggests that readily- 
identifiable, long-term adverse health effects due to nerve agent exposures only 
occur in human who show signs of acute toxicity or poisoning. That, is the available 
literature does not contain clear evidence that long-term, chronic adverse health ef- 
fects result from exposures that do not produce acute clinical signs and symptoms. 
However, I should note that the research in this area is sparse and in VA's judg- 
ment it should not be construed to mean that clinically important adverse health 
effects cannot or definitely do not occur in the setting of low-level neurotoxin expo- 
sures. The Coordinating Board has recommended that more research resources be 
allocated to address this question. I strongly agree with this approach. 

The DoD announcement regarding the demolitions at Khamisiyah has caused VA 
to reconsider and intensify its efforts related to possible effects of low-level expo- 
sures to chemical warfare agents. I have asked the Research Working Group of the 
Coordinating Board to provide a plan for addressing this issue as a component of 
the 1996 Working Plan for Research. As it now stands, the research working group 
has recommended a plan of action to: (1) fund toxicological research proposals on 
low-level chemical weapons exposure from a pool of already peer-reviewed proposals 
that had been submitted through a competitive process to the Army; (2) solicit re- 
search on the feasibility of conducting epidemiological investigations of low-level 
chemical agent effects; and (3) review the ability to confirm the identities and loca- 
tions of individuals in and around Khamisiyah with the goal of soliciting, if appro- 
priate, an epidemiological investigation. 

Based on the Coordinating Board's recommendation, $2.5 million dollars has al- 
ready been allocated to three new, peer-reviewed, basic science research projects in 
this area, and an additional $2.5 million dollar has been identified for future stud- 
ies. Funding for these new efforts will come from the DoDA^A collaborative research 
program that is funded as part of DoD's appropriation. 

While these efforts represent a good beginning, I have asked VA's Research and 
Development Service to take a completely fresh and broad look at these issues in 
light of the new information now provided by DoD. This includes asking them to 
develop a strategic plan for an environmental health research agenda that specifi- 
cally focuses on low-level exposures to neurotoxins that might result from chemical 
warfare agents or other military situations. Likewise, we are in the process of orga- 
nizing an international scientific symposium that bridges potential military and ci- 
vilian incidents involving exposure to those types of chemicals. Given the relative 
lack of worldwide scientific capability for assessing these issues in the traditional 
open and peer-reviewed manner in which the best science is carried out, we believe 
it is essential to bring together a multi-disciplinary group of experts to focus on find- 
ing innovative solutions to these perplexing issues. In this regard, I would again 
stress that if we are going to adequately research these questions, a major invest- 
ment of resources will be needed. 

In conclusion, I would reiterate that research related to the illnesses of Persian 
Gulf War veterans is highly complex, and this is especially so for the investigation 
of concerns related to possible low-level exposure to chemical warfare agents. VA is 
committed to meeting these challenges and obtaining the most accurate answers we 
can concerning the health of PGW veterans and their families. In this regard we 
are grateful for the assistance provided by the Presidential Advisory Committee on 
Gulf War Veterans' Illnesses, particularly insofar as the Committee played a central 
role in bringing to light this new information about probable troop exposure to sarin 
and cyclosarin. 

Thank you, Mr. Chairmen. That concludes my prepared testimony. 



33 

STATEMENT OF DR. KENNETH W. KIZER, UNDER SECRETARY 
FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS 

Dr. KiZER. Thank you. Good morning, Mr. Chairman, Members 
of the Committee. 

I'd Hke to take these few minutes for an opening statement to 
comment on the Department of Veterans' Affairs' Persian Gulf-re- 
lated programs, focusing especially on VA's responses to the recent 
reports about the probable low-level exposure of American troops to 
chemical warfare agents. And I will do my best to keep within the 
five minutes that you noted. 

SSCI Chairman Specter. Thank you. 

Dr. KiZER. A number of Senators have already commented this 
morning about VA's multi-pronged effort to provide medical care, 
to conduct research, to provide compensation and to outreach to the 
Persian Gulf veterans. VA's position since the inception of the Per- 
sian Gulf Registry in 1991 has been that all Persian Gulf veterans 
should participate in the registry program. I would today again re- 
iterate that VA encourages all Persian Gulf veterans, whether 
symptomatic or not, to avail themselves of the registry examination 
program, especially if they are concerned about possible exposure 
to chemical warfare agents in light of DOD's recent announce- 
ments. Further, we would encourage persons who have previously 
been examined as part of the registry program to request a follow- 
up examination if they have symptoms or concerns. 

I'd also take this opportunity to underscore, as we have at a 
number of other forums, that the VA has always remained open to 
the possibility that military personnel may have been exposed to a 
variety of hazardous agents, including chemical warfare agents, 
while serving in the Gulf War theater of operations. In this regard, 
I would note that a number of Members of Congress have recently 
asked whether the VA listened to the veterans who reported their 
belief that they had been exposed to chemical agents during the 
Persian Gulf service, and I would affirm, as we have, that we did 
listen to those veterans. Illustrative of this prior to DOD's an- 
nouncement at the end of June this year, VA had designed a clini- 
cal uniform case assessment protocol to detect clinical signs and 
symptoms related to possible neurotoxic exposures, and neurologic 
examinations and cognitive testing have been part of the protocol 
from early on. 

I would also add, as an aside, that as a result of this, the VA's 
diagnostic protocols and treatment programs do not need any sub- 
stantial revision in light of DOD's recent disclosures, although we 
are taking another look at this. 

Just a couple of other things I might note in this regard — when 
the reserve construction battalion unit of Persian Gulf veterans 
from Alabama, Tennessee, North Carolina and Georgia reported 
adverse health effects that they believed were due to low-level 
chemical warfare agents, we established a pilot medical assessment 
program at the Birmingham VA Medical Center to evaluate their 
health status. That was subsequently turned into a major referral 
center. 

Further, as evidence that we were heeding what the veterans 
themselves were sajdng is that in the National Health Survey of 
Persian Gulf veterans, which Senator Simpson commented about 



34 

this morning, specific questions are asked about possible exposure 
to chemical warfare nerve toxins, as well as mustard gas. 

At this point, I think it is very important to point out a couple 
of things. There is no biomarker, laboratory finding or diagnostic 
test that can be conducted for chemical warfare agent nerve toxin 
exposure. The diagnosis of conditions related to nerve toxins, 
whether they occur as a result of chemical warfare agents, whether 
they occur as a result of agricultural pesticides, or whether they 
occur as a result of hazardous industrial chemicals, is based on two 
things. First, the known or presumed exposure to the chemical 
agent, and second, sjonptoms or physical signs consistent with the 
known biological effects of the chemical. Absent definite exposure 
data or typical signs and S3anptoms, it is essentially impossible to 
make a definitive diagnosis of chemical related neurotoxicity. 

These same problems apply to conducting research in this area. 
Indeed, one of the most challenging problems that we have in con- 
ceptualizing and designing valid scientific studies of potential long 
term effects of low level exposure to chemical warfare agents is 
knowing what exactly one should measure and study when there 
were no signs or symptoms. It's very clear in my mind that if we're 
going to adequately research these questions, a major investment 
will be required to develop both the physical plant capabilities and 
the intellectual capital that are required to conduct these very dif- 
ficult studies. 

Now, in the interest of time let me move forward to make a few 
comments about the research programs that are underway. Again, 
Members have already commented about the number of studies 
being conducted by VA and other agencies. I think it is important 
to note at this junction that studies of low level chemical warfare 
agent exposure were not given as high priority as other research 
areas in the previous working plans of Persian Gulf veteran ill- 
nesses because military and intelligence sources had repeatedly 
stated that there was no use, presence or evidence of chemical ex- 
posure, or of exposure to chemical warfare agents. Those repeated 
assertions, combined with a lack of clear cut clinical evidence to 
support a finding of chemical warfare agent exposure, resulted in 
the Persian Gulf Veteran Coordinating Board focusing its research 
resources on other questions. And that decision was supported by 
the Institute of Medicine, the VA Persian Gulf Expert Scientific 
Committee, the National Institute of Health Technology Assess- 
ment Workshop and others. 

As a result of the recent announcements regarding probable ex- 
posure at Kamisiyah, the Coordinating Board immediately began a 
revision of its plan. The VA, through the Research Working Group 
of the Coordinating Board, has developed an action plan to address 
possible long-term health consequences of low-level exposure to 
these chemical warfare nerve toxins and mustard gas based on the 
new information. 

And let me just state again, in the interest of time, that Dr. Jo- 
seph, I think, has commented about the conventional medical 
thinking today that long-term adverse health affects due to nerve 
agent exposure only occur in humans who show signs of acute tox- 
icity. However, I would caution that the research in this area is 
very sparse and that in VA's judgment it should not be construed 



35 

to mean that clinically important adverse health affects cannot or 
do not occur in the setting of short-term, low-level exposures, espe- 
cially, if it's combined with other environmental stressors. The Co- 
ordinating Board has recommended more research be done in this 
regard, and I strongly support that approach. 

Just a few other details in this regard. The Research Working 
Group has moved forward on a plan — to pursue action in this re- 
gard. As it now stands, the Research Working Group has rec- 
ommended funding three toxicologic research proposals on low-level 
chemical weapons exposure from a pool of already peer-reviewed 
proposals that have been submitted through a competitive process. 
They're going to solicit research on the feasibility of conducting epi- 
demiologic investigations of low-level chemical agents, and like- 
wise, review the ability to confirm the identities and locations of in- 
dividuals in and around Kamisiyah with the goal of soliciting fur- 
ther epidemiologic investigation if it's appropriate. 

And while these things represent a good beginning, I've asked 
VA's Research and Development Service to take a completely fresh 
and broad look at these issues in light of the new information now 
provided by DOD. This includes asking them to develop a strategic 
plan for an environmental health research agenda that specifically 
focuses on low-level exposures to neurotoxins that might result 
from chemical warfare agents or other military situations. Like- 
wise, we're in the process of organizing an international scientific 
symposium that bridges potential military and civilian incidents in- 
volving exposure to these type of chemicals. Given the relative lack 
of worldwide scientific capability for assessing these issues in the 
traditional open and peer reviewed manner in which the best 
science is conducted, we believe that it's essential to bring together 
a multi-disciplinary group of experts to focus on finding innovative 
ways to solve these perplexing problems. 

In this regard, I would again stress that if we're going to ade- 
quately research these questions, a major investment of resources 
will be needed. 

Let me just conclude these comments by reiterating that the VA 
is committed to meeting these challenges and obtaining the most 
accurate answers we can concerning the health of our Persian Gulf 
veterans and their families. In this regard, we are grateful for the 
assistance provided by Congress, as well as, certainly, the White 
House, especially as manifested through the Presidential Advisory 
Commission on Persian Gulf War Veterans Illnesses and the very 
central role they have played in bringing this new information 
about probable troop exposure to light. 

With that let me stop and thank you for this opportunity to make 
these comments. 

SSCI Chairman Specter. Thank you very much. Dr. Kizer. 

Dr. Joseph, I begin the first question with you. We have the de- 
struction of a chemical weapons site in March of 1991. In October 
of 1991, you have an identification, clear cut, of its being a chemi- 
cal weapons site. You have the deputy director of defense saying, 
today, quote, "At this time, we do not know if U.S. troops were ex- 
posed to toxic chemicals during these events." Isn't the Department 
of Defense, really, AWOL and derelict in not facing up to the De- 
partment of Defense's responsibility in this matter as of today? 



36 

Dr. Joseph. I don't believe the Department is AWOL or derelict, 
Mr. Chairman. I think, as I read the Deputy Secretary of Defense's 
words this morning, he uses them in the same sense that Senator 
Simpson did. We do not know. I think everyone has said — the De- 
partment has said — since Mr. Bacon, a spokesman, on June 21st 
was the Kamisiyah announcement — that we think now that it is 
highly probable or plausible that there was an exposure to agent 
by that demolition team. 

Whether we know that yet or not, I think, is another story. And 
particularly, whether we know that yet or not in the sense of a 
level of exposure to toxic substance that might be thought to have 
health effects. 

SSCI Chairman SPECTER. Well, Dr. Joseph I have to disagree 
with you when you say plausible or highly probable. How much 
time is it going to take to have an assessment as to the responsibil- 
ity of the Department of Defense? You have Dr. Kizer's reference 
to the Presidential advisory commission. The investigators for that 
advisory commission said that the credibility of the Defense De- 
partment had been gravely undermined by its activities here. Do 
you disagree with that? 

Dr. Joseph. Well, we'll see what the commission, itself, says. 

In fact, Mr. Chairman, as I think ought to be clear from Mr. 
McLaughlin's testimony and mine, it was the rediscovery by the 
CIA and the DOD in light of the UNSCOM May '96 report that 
surfaced Kamisiyah. Kamisiyah is an important watershed inci- 
dent. We don't disagree with that at all. But it was the CIA and 
DOD in Hght of the May '96 UNSCOM report that resurfaced 
Kamisiyah. And in fact, it was the DOD who announced that find- 
ing, not the Presidential advisory committee. 

SSCI Chairman Specter. Well, why do we need a rediscovery 
and a redefinition, when you have an October 1991 determination 
that Kamisiyah was a chemical weapons site? And you have an 
elaborate sequence to find — described by the CIA, here in testi- 
mony today, all of which you knew about long ago, so that you have 
what really amounts to stonewalling, not to use excessive pejo- 
ratives — pretty hard to find an excessive pejorative, really — with 
the Secretary, the Deputy Secretary of Defense saying that we do 
not know if U.S. troops were exposed to toxic chemicals during 
those events. I mean, isn't conclusive, definite, established, proved, 
that U.S. troops were exposed to toxic chemicals? 

Dr. Joseph. I'd like to give an answer in two parts to that, Sen- 
ator. 

First, I think 

SSCI Chairman Specter. Were either of those parts yes or no? 

Dr. Joseph. Yes, they are. 

SSCI Chairman Specter. Okay. 

Dr. Joseph. The answer to the first part is no, that I don't be- 
lieve the Department is stonewalling. I think it's amply dem- 
onstrated in my testimony that we are treating Kamisiyah pit, 
Kamisiyah bunker, the other FOX and 256 detections and the 
Czech detections as instances of probable exposure. And that we 
are treating them from the investigational side and the medical 
side as if these are incidents of exposure. 



37 

SSCI Chairman Specter. Well, you talk about as if, and you talk 
about probabilities, but your conclusion is from your treatment, 
that U.S. troops were exposed to toxic chemicals during those 
events. That's what you're saying. You're treating them 

Dr. Joseph. As if they were. Yes, sir. 

SSCI Chairman Specter. As if. 

Dr. Joseph. Yes, sir. 

SSCI Chairman Specter. Well, the conclusion is that they were 
exposed, because that's why you're treating them. I mean, what's 
the point, Dr. Joseph, in the business as if? You have the testimony 
of Dr. Kizer, which you don't have to be credentialed, as you men 
are — extraordinarily so — that a diagnosis of nerve toxins depends 
on base of exposure and symptoms. And you have both of those fac- 
tors there. And you're treating them. 

So isn't it really a pretty common sense conclusion that the U.S. 
troops were exposed to toxic chemicals during those events? 

Dr. Joseph. Mr. Chairman, you've made — I think there's one 
error of logic in the statement you've just made. We do not have 
evidence of symptoms at the time of demolition. As Dr. Kizer said, 
and I said in my testimony, the current scientific knowledge — im- 
perfect as it may be — and I totally agree with what he said, and 
what I said about our need to get on and improve that knowledge — 
is that in the absence of acute s3rmptoms to low-level exposure, the 
current scientific opinion is that there are not chronic symptoms. 
What we have is a high probability, plausibility of exposure, no un- 
derstanding of acute symptoms at the time, now symptoms later — 
chronically later, several years later — and the question remains, 
are those symptoms related to that probable exposure at low level 
five years earlier? And I would submit that we do not know the an- 
swer to that question, and we are doing everything we can to find 
out. 

SSCI Chairman Specter. Well, my time is up. And I shall not 
ask any more questions, but I do conclude by sa3ring that you are 
treating as if, but that to me sounds like legalese for accepting the 
responsibility. And that the essence of what you're saying is that 
you're treating because these troops were exposed to toxic chemi- 
cals during those events. And when you talk about not contempora- 
neously knowing that the symptoms existed, you weren't there to 
inspect them contemporaneously with the event to see what the 
sjonptoms were, and there has to be an inference made after the 
fact. And it seems to me that five years after the event, that the 
Department of Defense and you, Dr. Joseph, would be well advised 
and certainly the Deputy Secretary not to say we do not know if 
U.S. troops were exposed on this face of the record. 

Senator Simpson. 

Veterans' Chairman SiMPSON. Thank you, Mr. Chairman, my fel- 
low chairman. 

I was in the Army. I was never in combat, very few of us were. 
I think the figure is of the 26 million of us who are veterans, per- 
haps 3 million of us were exposed to combat or even in a combat 
theater. As I wind down 18 years of this work, I find that the most 
vigorous activity comes from frustration, irritation, impatience and 
anxiety, because it takes time to get medical and scientific an- 
swers. Time is not what anybody wants. They want immediacy. 



38 

And I think everything in America is based on immediacy. Right 
now. Gratification. You name it. We want it now, whether it's 
consumer goods or other things. This is a tough issue. 

I do remember the training that we were exposed to certain pla- 
cebos and fake gases — and we were supposed to respond. Some- 
times that was to perform a self-inoculation with a little syringe 
crammed into your calves. There were guys who said even if they 
smelled the stuff, they wouldn't do that, because they were fearful 
of sticking a needle in themselves. It was interesting stuff as I 
watched all that. 

I do know enough about nerve gas, at least through my training 
many years ago at Fort Benning and in Germany, that if somebody 
were exposed to that stuff, there is an immediate symptom. It's 
called death. Is that not correct? 

Dr. Joseph. There are degrees of symptoms, but 

Veterans' Chairman Simpson. I know, but one of them is 

Dr. Joseph. Yes, sir. 

Veterans' Chairman Simpson. And then there is suffocation, and 
there is respiratory failure, there is congest — there are many 
things when somebody gets a whiff of that stuff. Is that not cor- 
rect? 

Dr. Joseph. That is correct, Mr. Chairman, and that's why we 
went back and looked at the unit medical logs and reports — looked 
for any reports of acute symptoms, illness or death in the areas of 
the demolition. And as I said in my testimony, we have not found 
them. 

Veterans' Chairman Simpson. And there were about 150 of these 
men on the ground — or what was that figure — that were part of the 
detonation team? 

Dr. Joseph. Well, Senator Simpson, I think that's part of the 
confusion here, what the number is. What I tried to do in my testi- 
mony is talk about how many were at which distance from which 
demolition. You are correct in terms of the actual site of the demo- 
lition, of the bunker, sir. 

Veterans' Chairman Simpson. Well, obviously we would all know 
medically and scientifically that high-level exposure would have 
been dramatic and hideous. Low-level exposure less so, but how 
less so? But what we do know is that no one at the site while doing 
that work expressed any discomfiture. Is that where we are? 

Dr. Joseph. That is the best information we have. 

Veterans' Chairman Simpson. That is what we know. 

Dr. Joseph. That is what we know. 

Veterans' Chairman Simpson. And those are interviews of those 
people, is that not correct? 

Dr. Joseph. That's correct. 

Veterans' Chairman Simpson. Personal interviews? 

Dr. Joseph. Personal interviews, and going back, looking at the 
medical logs, talking to the battalion commander and the company 
commanders, yes, sir. 

Veterans' Chairman Simpson. Okay. I heard that. You named 
two or three company commanders in the battalion. After the mis- 
sion was completed and the detonation and the bunker savagery 
was done, no one in that unit complained of any effects at all that 
would indicate anything. Is that correct? 



39 

Dr. Joseph. That is correct. 

Veterans' Chairman Simpson. Were there any chemical detec- 
tors? It seems hke a unit Hke that would have one on every — one 
on every shoulder. One on their belly, one on their ear. What did 
they have with regard to chemical detectors? 

Dr. Joseph. In my testimony, in my prepared testimony, Sen- 
ator, I go to some detail about the issue of what detectors were at 
the Kamisiyah bunker and pit sites and what occasioned. Initially, 
the information we had that there were no positive detections, 
there have been some changes of story. One, for example, one per- 
son now says that his M-256 kit was positive — was weakly posi- 
tive. 

Veterans' Chairman SiMPSON. Describe what each of these men 
carried because they knew that they were in an area of possible 
nerve gas and other agent presence. 

Dr. Joseph. I want to preface that by saying that, of course, it's 
not all one activity and one group of people. 

Veterans' Chairman Simpson. I understand. 

Dr. Joseph. The initial entry into the bunker site — let me speak 
about the bunker site. The initial entry into the bunker site in- 
cluded the activity of NBC — nuclear, biological, chemical — person- 
nel who were to look for any evidence of weapons of mass destruc- 
tion. As Mr. McLaughlin has said in his testimony, on that initial 
bunker investigation they did not see any. They, of course, would 
have with them both the first level MlAl, sort of least effective, 
or most sensitive and least specific, warning kit. Then they would 
be followed by the EOD, the demolitions team itself, who would go 
in and who would have with them that kit plus the M256, which 
is a more specific kit. We did not have FOX vehicles in that area. 

Now, there is a question as to whether there was — I believe there 
was one MlAl alarm that went off. And in response to that, de- 
pending on who you talked to who was there that day, some of the 
members of the 37th did put on their protective gear, some did not 
put on their protective gear. We don't have a verification about a 
second-level detector that would confirm the first. And in all that 
we know, when the actual explosion occurred, the members of the 
37th who had been at the site, laid the charges, had moved off 
about three kilometers or three miles from the site. And they were 
not in protective gear. There is a videotape that you may have seen 
that shows them not in protective gear. 

Veterans' Chairman SiMPSON. Well, my time has expired. But 
when it was all finished, everything you have said just now you've 
stated before 

Dr. Joseph. Yes. I beheve- 



Veterans' Chairman SiMPSON [continuing]. Somewhere? 

Dr. Joseph. Yes. I believe that's been said before. 

Veterans' Chairman SiMPSON. I mean, how many 

Dr. Joseph. Not in this detail, but 

Veterans' Chairman SiMPSON. How many years ago, or how 
many months ago, did you first say these things? 

Dr. Joseph. Well, this was not in our awareness until June of 
this year. 

Veterans' Chairman SiMPSON. That's right. It could not have 
been, could it? 



40 

Dr. Joseph. I believe it well, whether it could not have been 

is a difficult question to ask. And I don't know whether this is the 
point you want me to go back into what happened in all those in- 
stances. I'd be happy to do it as the reports came in. But it was 
not; it was not in the Department's awareness, nor in the CIA's 
awareness until it came together in June of this year. And we an- 
nounced it. 

Veterans' Chairman Simpson. Because you might have had a lot 
of trouble believing the Iraqis at that time was another reason 
back then. 

Dr. Joseph. Questions about whether the Iraqis were telling the 
truth, issues about different channels intelligence and medical — 
different perspective on what we were looking for back in '91, et 
cetera. 

Veterans' Chairman Simpson. I know one thing. My predecessors 
here took care of my veterans and my successors will take care of 
the veterans. That's what I know about the United States of Amer- 
ica and that's what I know about the Veterans' Affairs Committee 
that has endured all sorts of Administrations and all sorts of lead- 
ership. That includes my partner to my right and my partner to my 
left. One of them will take it over. Al Cranston, Strom Thurmond, 
Frank Murkowski and others down through the years have taken 
care of our veterans. 

SSCI Chairman Specter. And Alan Simpson. 

Veterans' Chairman Simpson. Yes, we'll I've done a little of that 
too, although I get tangled up with them sometimes. 

Thank you. 

SSCI Chairman Specter. Thank you very much, Mr. Chairman. 

Senator Kerrey. 

SSCI Vice Chairman Kerrey. Thank you, Mr. Chairman. 

Dr. Joseph and Mr. McLaughlin and Dr. Kizer, I appreciate very 
much your testimony, particularly the written testimony, there is 
a lot of detail in there. And as I — Dr. Joseph, your closing two 
paragraphs I think are more important to note. Particularly, the 
last one where you say that regardless of how we unravel all of this 
and how we assess blame or not blame, how we figure it all out, 
that the program that this Administration has established out of 
nothing will provide us with a basis for evaluating, first of all, 
health status of troops prior to deployment. Secondly, an evaluation 
of health risks in a deployment area. And thirdly, evaluate the 
health status coming out of a deployment. Is that not correct? I 
mean, do you see this program as having been, you know, been 
started by the President as an effort to get to the bottom and deter- 
mine whether or not there is a connection between observed health 
problems, very real observed health problems, and deployment it- 
self? Coming out of that evaluation, though, you see something as 
being produced that will be useful for future deployment. 

Dr. Joseph. Well, I certainly believe that. I think it is an unprec- 
edented effort that's been made. But I would not want to leave the 
impression at all that we do not see Kamisiyah as an important 
watershed change. Kamisiyah is a major change in the way we un- 
derstand what may have happened in the Gulf, what happened in 
the Gulf and what the possibility consequences may have been. 
Prior to Kamisiyah, we had a number of Gulf War veterans who 



41 

were ill and we sought explanations for those illnesses. Now we 
have evidence of possible, I would say plausible, chemical warfare 
agent exposures and we have to go back and look at all that clini- 
cal and other work we've done in light of those new disclosures and 
in light of that new understanding. And I think that's what Sec- 
retary White is attempting to say in his letter to Senator Thur- 
mond, whatever the choice of specific words. 

SSCI Vice Chairman Kerrey, well, Mr. McLaughlin, it seems to 
me that as I look at the events on the 2nd through the 10th of 
March and maybe. Dr. Joseph, your detailed evaluation of that or 
description of that moment in your testimony could cause you to 
comment on it as well. But it seems like the 37th Engineers who 
went in there, along with a unit of EOD people — I don't know 
about them — both of which were attached to the 82nd Airborne, is 
that correct? 

Dr. Joseph. In support of, yes. 

SSCI Vice Chairman Kerrey. They were in support of the 82nd 
Airborne. It looks, given all of the open statements that were made 
about the Iraqis with chemical and biological weapons, it looks like 
a pretty sloppy operation. I mean, my God, they. A, they didn't 
take enough charge in there to blow up all the weapons. They left 
weapons undestroyed. B, from the description that I got, that they 
set the charge and they had rocket fragments falling all around 
them. And C, it doesn't seem to me that they went in there with 
the proper amount of attention being given, the possibility, in any 
of these bunkers that the unmarked rockets — in this case a 122- 
millimeter rockets — and I don't know how much sarin there is in 
that weapon, but I presume that it's a sufficient amount of sarin 
that if it were to come down and detonate on one of these individ- 
uals who were blowing it, it could have produced the s3rmptom that 
Senator Simpson was describing, which is death. 

Did we have intelligence that indicated that these, contrary to 
the public statements at the time, which were that the Iraqi weap- 
ons were marked — did we have intelligence at the time to provide 
our troops that the Iraqi sarin and mustard weapons were not 
marked? 

Mr. McLaughlin. We did not know at the time that these weap- 
ons were at Kamisiyah, but we had issued a bulletin saying that 
for the benefit of all inspectors and troops who were associated 
with CENTCOM, that there was a danger of encountering un- 
marked chemical weapons from Iraq. So that bulletin was out 
there. 

SSCI Vice Chairman Kerrey. Mr. McLaughhn, a 122 millimeter 
rocket would come to your shoulder, right? 

Mr. McLaughlin. Right. 

SSCI Vice Chairman Kerrey. And the business end would be 
about like this? And again, I don't know how much sarin is inside 
of that thing. 

Mr. McLaughlin. About eight kilograms. 

SSCI Vice Chairman Kerrey. How much? 

Mr. McLaughlin. Eight kilograms. 

SSCI Vice Chairman Kerrey. Eight kilograms, which is a little 
shy of four pounds of sarin. How much — you know, if I set off four 



42 

pounds of sarin inside this room would it kill everybody in the 
room? 

Mr. McLaughlin. Kill everybody in a much larger radius than 
this room. 

SSCI Vice Chairman KERREY. So I'm dealing with a — pardon me? 
Eight kilograms is four pounds? 

Mr. McLaughlin. No, 20. 

SSCI Vice Chairman Kerrey. 20 pounds? 

Mr. McLaughlin. 2.2. 

SSCI Vice Chairman Kerrey. Yes, 8 times 2.2. Okay, sorry. I 
flunked another test. I can spell potato, though. 

[General laughter.] 

SSCI Vice Chairman KERREY. It seems to me, though, you've got 
a substantial risk to these troops. I mean, if 20 pounds of sarin will 
kill everybody in this room and then some, and you're saying, Mr. 
McLaughlin, that the intell at the time was that they were un- 
marked 

Mr. McLaughlin. Yes, that's correct. 

SSCI Vice Chairman Kerrey. It seems to me that the 37th engi- 
neer and the EOD people that accompanied them were given pretty 
bad order. Somebody sitting up at the top of the food chain must 
not have assessed this thing correctly. They put them — they put 
those troops at substantial risk, did they not? 

Mr. McLaughlin. Senator Kerrey 

SSCI Vice Chairman Kerrey. I mean, let's say that's Bunker 73 
sitting over there right now. Knowing what we know about what 
was in those warheads, how would you feel about going over and 
lashing up some charges to them and walking back about 100 me- 
ters and kind of hunkering down? Which is basically what I under- 
stand they did. And, you know, fire in the hole and let it go. All 
of a sudden I've got, you know, falling out of the sky — geez, I've got 
fragments falling on me. How would you feel about going out there 
today? Wouldn't you say that give the risk that that was an inad- 
visable operation? 

Dr. Joseph. Well, Senator Kerrey, I think you would understand 
more than most how much was going on in the area at the time. 
One of the senior Army leaders who was there described to me 
blowing one ammunition depot that was the size of the Washington 
mall with hundreds of ammunition bunkers in it. And that was 
only one among I don't know how many ammunition depots that 
were blown. 

SSCI Vice Chairman Kerrey. If you don't mind just stopping 
right there, I mean, now you've sized the thing pretty impressively. 

Mr. McLaughlin. This is a different site, sir. 

SSCI Vice Chairman Kerrey. I understand, but that site you 
just described could have been 100% sarin, could it not, Mr. 
McLaughlin? That entire site could have been 100 percent sarin. 

Mr. McLaughlin. Theoretically, but we do — from what we know 
of chemical weapons in the Kuwait theater of operations, we were 
only aware of chemical weapons stored at these two facilities that 
we've documented here — Kamisiyah and the other. 

SSCI Vice Chairman Kerrey. Thank you, Mr. Chairman. 

SSCI Chairman Specter. Thank you very much. Senator Kerrey. 

Senator Rockefeller? 



43 

Veterans' Ranking Member Rockefeller. Mr. Chairman, I have 
actually about seven questions that I would really like to have an- 
swered. I'll probably only have a chance to ask one or two in the 
first round. 

SSCI Chairman Specter. Go ahead. 

Veterans' Ranking Member Rockefeller. Will there be a second 
round? 

SSCI Chairman Specter. Take what time you need. 

Veterans' Ranking Member Rockefeller. Okay. Thank you sir. 

Dr. Joseph, I'm particularly interested in your statement that the 
DOD didn't pay too much attention to the early reports of chemical 
exposures because you questioned, quote, "How could you possibly 
have known that the soldiers would come home with these ill- 
nesses?" close quote. To me, that's an amazing statement. You're 
basically saying it's okay that somebody ignored reports of chemical 
releases because we didn't have any soldiers who were sick from 
them yet. 

It seems to me that the job of the person in your office is to an- 
ticipate these very issues, based on the best available evidence. So, 
let's just look at what we did know for a second. 

We did know that chemical nerve agents were in the Gulf. 

We did know, or strongly suspect, that Saddam Hussein had 
used nerve agents against his own people. 

We did know that DOD was prescribing an experimental drug, 
pyridostigmine bromide, PB, itself a nerve agent, for use by our sol- 
diers, and as it turns out, for the most part without their consent. 

We did know that DOD's own research suggested that PB might 
effective for use against soman but not against sarin. We knew 
that. You know that. 

Dr. Joseph. Not me, sir. We're talking about 1991. We knew 
that. 

Veterans' Ranking Member ROCKEFELLER. All right, you didn't 
know it. Well 

Dr. Joseph. We knew it in 1991, Senator. 

Veterans' Ranking Member Rockefeller. Sarin was the very 
nerve agent that we knew Saddam had because we and our allies 
had, in fact, supplied them in an earlier time. 

We did know that our soldiers would face horrible conditions in 
the Gulf, including a lot of insects. As you described, there was a 
lot going on. That doesn't mean that the safety of the troops, the 
health of the troops, becomes less important. We did know that 
DOD was likely to make extensive use of insecticides and 
repellants in the Gulf. 

So. Dr. Joseph, knowing just these things, don't you think that 
you would have wanted the Department of Defense to have at least 
a heightened awareness of possible chemical exposures? To be look- 
ing for these reports? To be assuming — leaning over to assume — 
that they might be true and therefore there should be heightened 
activity just based upon what we did know? 

And wouldn't we want our soldiers to assume that bombings and 
demolitions of Iraq's weaponry during and after the war, that 
maybe, just maybe, would result in some toxic releases? Wouldn't 
that have been a pretty good operating assumption? 



44 

Dr. Joseph. Well, with regard to the first part of you comment, 
Senator, that we, the department thought it was okay because we 
didn't know, I mean, I would take very strong exception to that. 

With regard to the substance of your comments, I would remind 
you that this was in 1991. There was, as I understand it, historic — 
this, of course, is a different time, different people, different Ad- 
ministration, and there was at that time extreme thought given to 
all factors that you have described. I'm sure that was so. 

I also know historically that in 1991, as both Mr. McLaughlin 
and I have said, that that initial UNSCOM message came in in a 
different channel. It came in through the intelligence channel, that 
it was not correlated medically. I am not saying whether that was 
right or wrong or the best thing. You know, I'm not justifying that 
decision. What I'm trying to do is to describe to you today what 
happened in 1991 with the first information that came in. It did 
not come only to the Department of Defense. That initial UNSCOM 
report was widespread in the intelligence and national security ap- 
paratus. And it was not placed in it's — I agree with you — proper 
and relevant context as to its medical significance. That is what 
I'm saying that happened in 1991. 

Veterans' Ranking Member ROCKEFELLER. And that it was not 
properly placed? I'll — well, let me go ahead. 

Dr. Joseph. And it submerged, if I may, it submerged in the ava- 
lanche of material or the flood of material that was coming in at 
that time. 

Veterans' Ranking Member Rockefeller. No excuse. 

Dr. Joseph. I don't believe excuse, either. 

Veterans' Ranking Member Rockefeller. No excuse whatso- 
ever. 

Dr. Joseph. I'm not making an excuse, Senator. I'm telling you 
what we believed happened in 1991. 

Veterans' Ranking Member Rockefeller. And there's been a 
long time since 1991. Reference was made by the Chairman earlier 
to this letter coming from the Deputy Secretary on the day that 
we're having a hearing. It's little bit like the way news of the blow- 
up of the deposits of weaponry came about — the Defense Depart- 
ment announcement was a hastily called press release about 24 
hours after the White House, I believe, had said that they were 
going to come out with it. So you can deny that if you want. 

Dr. Joseph. I believe it. May I answer? 

SSCI Chairman Specter. You may answer. Dr. Joseph. 

Dr. Joseph. I believe that both Mr. McLaughlin and I have laid 
out to you to the best of our ability, what the sequence of events 
of awareness of the various UNSCOM inspections and the U.S. 
military and intelligence establishments' knowledge of those an- 
nouncements were. We're not doing that, I'm not doing that as an 
excuse for what has happened. We're trying to lay out what we be- 
lieved happened. And I think the record does show that as soon as 
we had awareness of the existence and significance of this event in 
Kamisiyah — that's the whole point of the end of my — this is a 
war — we then made that public. 

Veterans' Ranking Member Rockefeller. Yes, and in the letter 
from the Deputy Secretary, he talks about DOD-sponsored research 
into possible effects of low-level chemical exposure that will be 



45 

funded for a total of $5 million. I'm not even sure of this, but I'll 
bet that's the $5 million that Bob Byrd put in for the purpose of 
having you all do that. 

Now, I'm very interested in the work of your Persian Gulf Ill- 
nesses' Investigation Team. That's the investigation team that re- 
ports directly to you, am I right? 

Dr. Joseph. It reports to me, yes. 

Veterans' Ranking Member Rockefeller. I think it was just last 
month that this DOD investigation team issued a report on low- 
level nerve agent exposure, subject to some discussion this morn- 
ing. The DOD report concludes that there is no credible evidence 
for chronic illnesses caused by exposures to nerve agents at low 
levels in the absence of acute illness or exposure, and that such a 
process cannot be reasonably advanced. It says that research in 
this area is unlikely, in the extreme, to enhance our understanding 
of Gulf War illnesses. Do you agree with that, or do you reject that 
report and request further work? 

Dr. Joseph. Well, I asked for that report and at the same time, 
I asked the Armed Forces Epidemiology Board, a distinguished 
group of experts who've been serving the department as a board 
since 1941, to undertake a review of the world literature and to 
give us a recommendation or a finding on the same topic. They 
came to essentially the same conclusion. I'd be happy to provide 
you that report as well, sir. 

Veterans' Ranking Member ROCKEFELLER. So, is this a possibil- 
ity. Dr. Joseph, that you believe we should explore? do you think 
there is a reasonable medical possibility that low-level exposure 
can cause long-term effects? 

Dr. Joseph. I think 



Veterans' Ranking Member Rockefeller. Even where 

Dr. Joseph. Excuse me, sir. 

Veterans' Ranking Member Rockefeller [continuing]. There 
has been no acute illness or exposure? 

Dr. Joseph. I think both Dr. Kizer and I spoke directly to that 
point. The current overwhelming base of medical opinion and 
knowledge is that that is not so. Both of us have said and both of 
us believe that that knowledge base is not adequate and that we 
need to look further into that issue. Yes, sir, to your question. 

SSCI Chairman Specter. Senator Rockefeller, if you want to 
pursue this line, go ahead. 

Veterans' Ranking Member ROCKEFELLER. I have one more ques- 
tion, if possible. 

SSCI Chairman SPECTER. No, no, go ahead. I just — if you have 
a great deal more, I think we ought to yield to some of the other 
members, but if you have another question on this line, proceed. 

Veterans' Ranking Member ROCKEFELLER. If it's all right, I'd like 
to ask one more 

SSCI Chairman Specter. Go ahead. 

Veterans' Ranking Member Rockefeller [continuing]. On this 
one. 

I organized a briefing this past May to which DOD did, in fact, 
send somebody to, and we heard a presentation by Dr. Abou-Donia 
from Duke University, which very much confirmed earlier work 
done by a courageous scientists by the name of Dr. Jim Moss. Dr. 



46 

Abou-Donia told us about the very likely multiple effects — syner- 
gism — of exposure to pyridostigmine bromide, DEET and 
permythrin, an effect which I know you do not support. But I un- 
derstand that the department has provided sarin to Dr. Abou- 
Donia's lab to study its effect in combination with DEET and 
pyridostigmine. 

Now, Dr. Abou-Donia warned my staff that his findings are not 
complete and have not yet been peer reviewed, do you want to tell 
us what his preliminary findings are? 

Dr. Joseph. I would say first that you and I can argue to great 
length the merits of the Abou-Donia or the Moss research, but in 
my business. Dr. Kizer's business, we do not regard research as 
having validity until it is peer reviewed and published. In both 
cases, this has not been the case. I could get into you — I probably 
need to refresh my recollection about the various things about the 
particular research on chickens that Dr. Abou-Donia has done or 
the research on cockroaches that Dr. Moss has done, and to why 
we think there is real open question about whether that research 
points with any relevance to possible human effects. But the proof 
of that pudding will be in peer review and publication. 

Veterans' Ranking Member Rockefeller. What he reported to 
us just yesterday I thought was interesting. First, he said sarin 
causes inaction of certain enzymes in animals, and in most cases, 
this is reversible, and recovery from sarin exposure is complete. 
That is consistent with your reviews, I would expect? 

Dr. Joseph. It is and, of course, it's one of the bases for think- 
ing — for the scientific opinion that exists that without acute effects, 
you do not have long-term chronic effects. 

Veterans' Ranking Member Rockefeller. But what he also told 
us that when very low doses of sarin are given in combination with 
pyridostigmine and DEET, the enzymes do not recover — this is his 
quote — "the enzymes do not recover, and we believe the damage is 
irreversible," close quote. 

Of what significance would these findings be if they do, in fact, 
meet the standards of peer review? 

Dr. Joseph. Well, with all due respect, Senator, whatever Dr. 
Abou-Donia did or did not tell you in private conversation yester- 
day, without seeing any of the data, without having any knowledge 
of how it fits into a peer-review structure, I really couldn't com- 
ment on that. I don't know what it means. It means — in fact, it 
means very little to me. It could, in the long event turn out to have 
some significance, but you've shown me no basis for thinking that 
that's so in this discussion. 

Veterans' Ranking Member Rockefeller. And I've asked that 
he send the preliminary report to your attention, and I'll be inter- 
ested in your reaction. 

Dr. Joseph. May I, if I may just prolong my answer because I 
think it's important here. You yourself mentioned that we have 
continued to fund his research. I think that is evidence that what 
we're far from are trying to close off these avenues of inquiry and 
research, we are interested in pursuing them wherever they will 
lead. But to know what we have got once we pursue them, that has 
to be done in the proper way, and as has been said, it takes time. 



47 

Veterans' Ranking Member Rockefeller. So you have a won- 
derful advantage, because you and others are able to say, well, 
until it's peer reviewed, until it's absolutely in its final form, I real- 
ly don't know how I could comment on it. In other words, anything 
which comes up, you can push aside because you say, well, there's 
no scientific evidence. 

Now I happen to have been around this country and in my own 
state, and I happen to have seen an awful lot of people — hun- 
dreds — who are suffering illnesses that I've never seen before, and 
symptoms I've never seen before. You've got the gift and the luck 
of being able to say, well, I can't say definitively what this might 
be because we have no final proof. 

But I just want you to know there's tens of thousands of people 
around this country who are suffering, and have been suffering for 
five years. The war was in 1991; we had a long time to prepare for 
it. And they're probably not quite as sympathetic as some of your 
colleagues are to just being able to say until I have the final proof. 

Dr. Joseph. Well, if you're suggesting. Senator, that we're 
uncaring or insensitive to the veterans, I think the evidence is ex- 
actly to the opposite. But your stretch between those two Abou- 
Donia discussions and the veterans who are indeed ill and suffer- 
ing is a long stretch indeed on the basis of the evidence you have. 

Veterans' Ranking Member Rockefeller. And certainly, is a 
long stretch in your mind. I understand that very well. 

Thank you, Mr. Chairman. 

SSCI Chairman Specter. Thank you, Senator Rockefeller. 

Senator Shelby. 

Senator Shelby. Thank you. Thank you, Mr. Chairman. Dr. Jo- 
seph, we've been over some of this before. And I'll try to get to the 
crux of it. As you'll recall, I was tasked by Senator Nunn back in 
'93 with other people on the Armed Services Committee to look into 
this. And we came up with the evidence that we furnished the Pen- 
tagon that the Czechs had detected, I believe on more than two 
incidences, the presence of chemical agents in the Gulf, that the 
French had also detected chemical agents, and at that time I recall 
the Pentagon denied all of this. They said it wasn't there; had no 
evidence of that. And then it came to light later that the Pentagon, 
through the Central Command, had been notified of this. It was in 
the bowels of the Pentagon somewhere. 

Now, what I'm getting at is something that bothers a lot of us. 
And it's deeply troubling to the public. The rediscovery, or resur- 
facing of reports of chemical agents and so forth in the Pentagon's 
got to be disturbing to the American people, because this has been 
going on since, at least since '93, probably back to '91. And yet, we 
come before this Committee today and I believe the phrase one of 
us used was, the rediscovery, in other words, something is there. 

SSCI Chairman Specter. Right. 

Senator Shelby. Something that has been denied. Candor is im- 
portant. You know, a lot of us, probably most people on this Com- 
mittee, this Joint Committee, have really gone to great lengths to 
believe the Pentagon, you know, on all this. And then you — we see 
doubts there when there's all this denial all the time. 

Now, I want to get into something that's deeply disturbing to me. 
It's my understanding that it was reported that as many as eight 



48 

days of information from March 1991 are missing from chemical 
warfare logs. Gap again. Remember the old gap in the tapes and 
so forth? If you go back 20 years ago. This is the same time, Dr. 
Joseph, that the Army destroyed the Kamisiyah weapons storage 
facility in question. Yet, it's our understanding that there's a gap 
in the logs. Are any of you on the panel today aware of these logs, 
and can you explain why there are gaps in information that could 
be so critical to the central question here. 

Dr. Joseph. 

Dr. Joseph. I have heard recently, I can't remember whether it's 
in the last day or two, of that eight day gap. I don't have personal 
knowledge of it, but I wouldn't be totally surprised if it were true. 
I'm sure if you go looking for any particular piece of information, 
related to the logs, et cetera of the war, you might find difficulty 
in finding it depending on where it is. 

Senator Shelby. Even 

Dr. Joseph. I don't 

Senator Shelby. Even if this was a critical eight day period in 
here and wouldn't it 

Dr. Joseph. And that's now the question. 

Senator SHELBY. Let me finish. 

Dr. Joseph. Yeah. 

Senator Shelby. Wouldn't it bother you to say, gosh, what's 
missing? This is critical to this — tying all this together. Perhaps 
answering a lot of questions. What happened to these missing logs 
which obviously contained raw information that could help criti- 
cally in this evaluation? Go ahead. Doctor. 

Dr. Joseph. And that's exactly why. Senator Shelby, in the part 
of my final portion of my testimony which I didn't get to deliver, 
and in Secretary White's letter this morning, among the things the 
Department is doing and response to the Kamisiyah and all the 
watershed changes that it's made, is one, he has tasked the Army 
to have the inspector general of the army go back and run the chro- 
nology of Kamisiycih. And two, he has tasked the assistant to the 
Secretary of Defense for intelligence matters to go back and run 
the chronology of Kamisiyah in the Department of Defense. That's 
the kind of step that you take when you want candor and you want 
to find out what happened back there in 1991. 

Senator Shelby. But isn't candor the — should be the order of the 
day; not denial? Not saying, gosh, we rediscovered this. We found 
something that was in doubt to begin with, you know, that other 
people had said was there, and there was denial. Candor's impor- 
tant. Isn't, honesty? 

Dr. Joseph. Of course it's important. And you know, I've heard 
many other officials in the Department of Defense say, previously, 
we have no persuasive evidence. We have no — I have said that my- 
self on numerous occasions in the past. And I did that on the basis, 
and I believe the others did on the basis of their very best knowl- 
edge at the time. Now, our knowledge has changed with 
Kamisiyah, and we're saying something very different. 

Senator Shelby. Mr. Chairman, if you'll indulge I won't take but 
a minute. 

I've received. Dr. Joseph, some disturbing calls regarding the 
Gulf War Syndrome program at the Walter Reed Araiy Medical 



49 

Center. I've been told by more than one individual that the staff 
there, of this program, are telling patients at Walter Reed — of all 
places — that their ailments are psychosomatic. Are you aware of 
this treatment of our service members and if you're not would you 
look into it? 

Dr. Joseph. I will look into that specifically and respond to you 
forthwith. 

Senator Shelby. Dr. Joseph, could you comment on the recent 
study that has found an increased presence of medical problems 
with the women that served in the Gulf? 

Dr. Joseph. Well, if you're — there was a newspaper article that 
I saw yesterday that described that study — that's my only knowl- 
edge of it. As you probably know, and as we can provide you in 
great detail, we and the VA have a whole range of studies going 
on, reproductive health studies, hospitalization studies, morbidity 
and mortality. And in our reproductive health study to date and I 
believe in yours as well, Ken, we have no evidence for an elevated 
rate of reproductive health problems in women. I'm not sure about 
the VA, so I shouldn't put words in your mouth. But I know that's 
true — at the current stage — it takes time, in our study. 

Senator Shelby. We know. 

Dr. Joseph, if there were more than a thousand rockets that con- 
tained sarin, that were destroyed by the 37th Engineering Battal- 
ion — and this is what we've been told — according to eyewitnesses 
interviewed by various publications, that the U.S. explosives set off 
rockets in all directions for days in the area. Do you dispute that? 

Dr. Joseph. I think that's probably a question for Mr. 
McLaughlin to respond to. And we're awaiting the modeling which 
will give us a sense of what the cone of — or that zone of exposure 
would be. 

Senator Shelby. But modeling is based on basic assumptions on 
anjrthing, is it not? 

Dr. Joseph. Yes, sir. Number of rockets, what was in the rocket, 
what the meteorology of the day or the time would be. And also, 
what you assume is the lowest level that might lead to harm and 
maybe some other things. 

Chairman Specter. Mr. McLaughlin, if you want to comment, 
will you try to do it briefly because we're trying to conclude the 
hearing. 

Mr. McLaughlin. Yes. 

In the case of the second area that we're modeling, the so-called 
pit, we're assuming an explosion of about 550 rockets. I could tell 
you how we arrived at that figure, if you wish. We're not done with 
that modeling, but that's the quantity of weaponry we believe was 
exploded there. And we're modeling it with the upper limit assump- 
tion in order to get the most extreme outcome we can. 

Senator Shelby. Mr. Chairman, thank you for your indulgence. 

SSCI Chairman Specter. Thank you. Senator Shelby. 

Senator Robb. 

Senator RoBB. Thank you, Mr. Chairman. 

I certainly shared everyone's frustration about our inability, at 
least to date, to define exactly what the problem is and how to re- 
solve it. I have a question that I'd like to ask in very general terms, 
to get away from some of the more precise matters that I think re- 



50 

quire a more detailed analysis. And that's whether or not we have 
any evidence of CW agents that we know, on the basis of prior test- 
ing, to have the kind of delayed effect that might at least explain 
sjonptoms that did not manifest themselves at that time, if the con- 
temporaneous interviews are correct, but have clearly manifested 
themselves since then in ways that are very troubling at this time. 

Number one, are there known agents of this sort in the world in- 
ventory? 

Number two, are there any such agents that Iraq was known to 
possess — or any that we may have had possession of at one time 
that we may have somehow, directly or indirectly, provided to the 
Iraqis before the Gulf War? 

Dr. Joseph. I don't believe so, Senator, but I'd like to just qualify 
that remark by saying I want to get back and check the list and 
be sure we've got all the medical data before I say so. But I don't 
believe so, I don't believe there is anything, you know, our knowl- 
edge of what currently exists as chemical or biological weapons, 
which would produce this picture that we're describing, particularly 
the no acute effects and later chronic effects. 

Senator ROBB. Mr Mclaughlin, from the intelligence side, do you 
know of anything that would 

Mr. McLaughlin. I do not. 

Senator Robb [continuing! . Meet that description? 

Mr. McLaughlin. No, I do not. 

Senator RoBB. All right. Let me just ask one other question and 
I'll let the 

Dr. KlZER. Could I also respond to that? 

Senator Robb. Please, Dr. Kizer. 

Dr. Kizer. From VA's perspective, we are privy to what is pub- 
lished in the open, peer reviewed literature; what information 
might be contained in internal documents or classified we would 
not know about. 

Senator RoBB. I realize that we could look to other sources, but 
gather that, as far as the medical understanding of the effects of 
these CW agent's is concerned, we don't know of anything that you 
would describe as the most likely agent to induce these kind of 
long-term, but not immediate, effects. 

Dr. Joseph. That's correct. 

I think one other slight caveat, going back to Ken Kizer's earlier 
testimony, we don't know what we don't know. And the whole area 
of human response to chemical or biological warfare agents is one 
in which it is difficult to do research, animal or human certainly, 
and in which much of the detail and assurance that we have in 
other areas in medicine we don't have. And I think that's why the 
issue of now pushing on with that becomes important. 

Senator Robb. Well, let me ask you this. As a part of your addi- 
tional research and/or modeling, are we cooperating, say, with the 
Japanese, who have had the sarin attack in the subway, in terms 
of any follow-up with respect to residual symptoms that they might 
have, or with some of our own forces that we know were exposed 
to mustard gas or other things that we know were at least present 
and have been positively identified? Do we have any scientific anal- 
ysis of the long-termi effects of those chemical agents on people 
whom we know were actually exposed to those agents? 



51 

Dr. Joseph. Well, of course, now that we presume that there was 
at least some exposure in the Gulf to U.S. troops, that is the whole 
importance of having the clinical evaluation program base to look 
out in 

Senator ROBB. And I understand that. What I'm asking is, are 
there other collateral studies or evidence that would at least help 
to establish that there are the kinds of residual effects here? Or do 
we believe, in effect, that we're dealing with a phenomenon that 
has yet to be discovered and analyzed in a way that would enable 
us to treat it? 

Dr. Joseph. I believe we have a channel for continuing sharing 
of information on the topic with the Japanese, but I know of noth- 
ing more formal than that, in light of what you're describing. 

Dr. KiZER. Let me add that the VA has been collaborating with 
the Japanese investigators through one of our environmental haz- 
ard centers long before this announcement was made in June. And 
I would also note that that is the reason why we're organizing this 
international symposium — that is, so that we can capitalize on the 
knowledge that may exist in countries other than the U.S. 

Senator Robb. Let me ask just one final question of either of our 
medical experts, and that is, what is it that we need to know, or 
would like to know, in order to solve this particular mystery? Wliat 
is it we're looking for that would give us the kinds of either in- 
sights or scientific evidence to support some definitive conclusion? 

Dr. Joseph. I would say two things, Senator. One is we need to 
know, we're looking to know whether in the really massive amount 
now of clinical data that we have between the VA and DOD, 
whether there are any patterns, whether there are any signposts, 
whether there is any clustering that would lead us to some focus 
on a particular issue, in particular this one. That I think we have 
done an awful lot to put in place. 

The second issue is we need to know the answer to the question, 
can we be confident that without acute health effects of low level 
exposure there are no long-term chronic health effects. And I think, 
as we've both said, that's what the current scientific body of opin- 
ion is, but we can't be satisfied with that answer. Those two ques- 
tions are the most important. 

Senator Robb. With sufficient resources, do you believe that 
those questions can be answered? 

Dr. Joseph. I think the first question we've already put a great 
deal of resources into, and I think that question can be answered, 
although the great difficulty comes, it's often a question of proving 
the negative. 

On the second one, I wouldn't hazard an opinion. I know addi- 
tional resources and additional work on the topic will get us fur- 
ther down the road, but whether it would get us definitively to a 
point, I couldn't say, sir. 

Senator ROBB. Thank you. 

Dr. Joseph. We need to do it. 

Senator ROBB. Mr. Chairman, my time is up, and I thank you. 

SSCI Chairman Specter. Thank you very much. Senator Robb. 

This is obviously not the final hearing on this matter. There are 
a great many questions left unanswered. I'm hopeful we'll be able 



52 

to conclude the hearing at this point. Senator Rockefeller, do 
you- 



Veteran's Ranking Member Rockefeller. Sort of a question and 
a half. 

SSCI Chairman Specter. Okay. 

Veterans' Ranking Member Rockefeller. Is that all right? 

SSCI Chairman SPECTER. Why don't you take two questions? But 
two questions, but only two questions. 

Veterans' Ranking Member ROCKEFELLER. No more. 

SSCI Chairman Specter. Okay. 

Veterans' Ranking Member Rockefeller. Let's get back to the 
DOD investigation team report. Dr. Joseph. That report rejects the 
primary scientific evidence that supports toxicity of a low-level ex- 
posure, which is a 1975 study by Lohs, because it's based on a work 
by a Dr. Spiegelberg in 1961 and 1963. Amazing that there's noth- 
ing more recent than that. 

Dr. Joseph. Well 

Veterans' Ranking Member Rockefeller. I'll finish asking my 
question, then you answer. 

In rejecting the 1975 study, DOD's investigation concludes that 
the underlying studies were flawed because the workers who were 
studied, quote, "Were making a large number of different agents 
and were constantly shuttled back and forth between different 
chemical agents, including pesticides." So the underlying studies 
were just too uncontrolled in the view of DOD, is that right? 

Dr. Joseph. No, I read it quite differently. Senator. The '61 or 
'63 work was itself a description of the actual research. The actual 
research was done in the late 1930's and 1940's in Nazi Germany 
looking for chronic health effects of factory workers who had been 
exposed to levels of chemical agents. Now, those factory workers, 
were probably not in the best of health, many of them were prob- 
ably slave labor in the factories. Two, we know nothing about the 
prior state of their health. Three, they were exposed not only to a 
variety of agents, but they were exposed, those that survived, over 
a long period of time. That's 1930's, 1940's work, and that's what 
all the rest of the chain you described is solely based on, sir. 

SSCI Chairman Specter. One more question, Senator Rocke- 
feller. 

Veterans' Ranking Member Rockefeller. And that's all I'll 
have. 

I'm very aware. Dr. Joseph, that you weren't here in 1991, you 
were appointed by the President in 1993, the current President. I 
understand that. But I am also aware that the views that you've 
expressed in your public statements, in essence, are that you would 
not really have done anything different if we had to do this all over 
again in the Persian Gulf War — let me finish my question — regard- 
ing protection of soldiers' health. 

Now, if that is not a fair summary, based upon your current 
state of knowledge, what do you think we should have done dif- 
ferently to protect our soldiers and investigate their illnesses? 

Dr. Joseph. I will tell you, I'll give you a brief resume and I'd 
like to also respond to you on paper in greater detail. 

What would I not do differently first. I believe — and I know we 
may differ on this — that the people who took the decision to immu- 



53 

nize our soldiers in the Gulf and to provide them with 
pyridostigmine in that setting, took the right decision. That is my 
belief and I'd like to believe that if I were in the same position I 
would have done exactly that. 

What would I have changed? 

Veterans' Ranking Member Rockefeller. Even though it was 
going to be ineffective against the agent which we knew 

Dr. Joseph. Well, that's — excuse me. 

Veterans' Ranking Member Rockefeller [continuing]. Was at 
play: sarin. 

Dr. Joseph. That's, I believe, an oversimplification. Senator. We 
did not know that they might not be exposed to soman. I think I 
differ with your characterization of PB as counterproductive or 
harmful, I guess was the word you used. In the case of sarin expo- 
sure, I don't believe that that's quite accurate. And a simple an- 
swer to your question, yes, sir. Even though what we knew we 
knew, as I understand it, and whether they needed protection I 
think that was absolutely the correct decision to take. 

Now, what would I have different? Well, one of the things I 
would have different is expressed in some detail in my testimony 
in terms of the things we have done in the last two years to build 
a different way, an improved way to look at before, during and 
after deployment, the assessment of health in our troops. That's in 
detail in my testimony. I can give you even more detail than that 
if you want it. I think it would have clearly been better to have the 
kinds of pre- and post-health assessment information, to have the 
kind of environmental health monitoring, to have the kind of com- 
bat stress teams on the ground, to have the kind of preventive 
medical teams on the ground, the way we do in Operation JOINT 
ENDEAVOR. That's easy with hindsight to say. But I would have 
that differently. 

Secondly 

SSCI Chairman Specter. If this is going to be protracted. Dr. Jo- 
seph, would you supply it in writing please? 

Dr. Joseph. Forty-five seconds more and 

SSCI Chairman Specter. Go ahead. 

Dr. Joseph. Okay. The other thing I would have differently is I 
would have a more effective link between the various operational 
intelligence and medical views of what might be going on in thea- 
ter. I think we've learned that lesson out of the desert. I think we 
do do it much better now. Those two things I would have dif- 
ferently. The basic decisions. Senator, I think were the correct 
ones. 

Chairman Specter. I have a few 

Veterans' Ranking Member ROCKEFELLER. Thank you, Mr. 
Chairman. 

SSCI Chairman Specter. Thank you very much. Senator Rocke- 
feller — a few words to say in conclusion, but I want to yield at this 
time to my colleague. Senator Simpson with one prefatory note. 
When I came to the Senate 16 years ago, Senator Simpson was 
Chairman of this Committee. He's done a great many things in the 
interim before returning to the Chairmanship. But we all know 
he's about to depart. This is the last week of the Senate. We expect 
to conclude our business yet this week. And he has brought a rare 



54 

combination of intellect and balance with extraordinary humor and 
levity to guide us in so many of our deliberations. He's received a 
lot of accolades, so I'll conclude mine at this point. 

Veterans' Ranking Member ROCKEFELLER. I will join you in that 
assessment, Mr. Chairman. 

Veterans' Chairman SIMPSON. You can both go ahead a little fur- 
ther. 

[General laughter.] 

Veterans' Chairman Simpson. No need for you to fall short. 

I thank you. One of these gentlemen will be the Chairman of the 
Senate Veterans' Affairs Committee next year, and I wish them 
well, because they will continue to be besieged by emotional pres- 
sure from groups and people throughout the United States that are 
almost overwhelming. They are fueled by a media that will pick up 
any possible thing about any person who is sick or ill. The next 
chairman will have to do the right thing in the midst of emotion, 
guilt, pressure, frustration, all the things I spoke of in the begin- 
ning. 

The part that has been very frustrating for me all the years of 
my Chairmanship and serving with Al Cranston as Ranking Mem- 
ber, is to see finally people come and testify and they say, "We 
don't really know what the hell went on, but we live in a great 
country, and we're dealing with veterans, so just pass the legisla- 
tion." Then nobody ever talks about how you pay for it. I know 
that's a sick idea. My problem is that I was on the Entitlements 
Commission. Members of Congress continue to pour out the Treas- 
ury to anybody, regardless of sound medical or scientific evidence. 
And at some point, somebody — usually one of those poor veterans 
or their children or somebody — is going to have to pay the bill. The 
bill today is six trillion bucks. We have two candidates for Presi- 
dent and neither one is speaking on that issue in any way whatso- 
ever. Medicare, Medicaid, Social Security, Veterans' Benefits, Con- 
gressional retirement, and Federal retirement are all depending on 
the Federal Treasury, and none of us at this table will be affected 
in any way at all. The only people affected will be people between 
the ages of 18 and 40 because they will have to pay the bill. When 
it comes due, they'll be just wandering around in the swamps. They 
won't even know what hit them. 

So those are the things that can get you labeled "anti-every- 
thing" — anti-veteran, anti-caring, slob of the earth. I've been called 
ever3rthing you can imagine in my work as Chairman of the Veter- 
ans' Affairs Committee. But I tell you what, I've learned to enjoy 
the combat with the veterans organizations — and boy, there are 
some tough ones. They do good work and they're sincere. 

But the point of any hearing should be — and I commend Senator 
Specter and Senator Rockefeller — what happened? When did you 
find out? What was done? What are you going to do? 

You know, you could have 500 reports on Agent Orange saying 
there "ain't nothing there," and then one guy comes up to refute 
that and it's the front page of every paper in America. Let me tell 
you, ladies and gentlemen, if there were something to do about 
Agent Orange, it would have been done by now, but there's no way 
to tag it down and tie it down. If there had been, those lawyers 



55 

would have done it when they got the settlement out of the chemi- 
cal-producing companies for $200 million and walked away. 

We need to stick with — and it's going to be hard for these two 
gentlemen — the patience and try to ward off those who come in and 
know how to work it, and know how to pry the lid off Fort Knox. 
I've heard all sorts of witnesses over the years on Agent Orange 
and prisoners of war. I remember the guy that said, "I know where 
they are. They're in a cage. We've got pictures of them." I said, 
"Show them to me and Al Cranston." Then he said, "I'll give it to 
you for two million bucks." I said, "Get your butt out of here." We 
took care of him. 

That's the kind of stuff that goes with this Committee on Veter- 
ans' Affairs. We see research on chickens and cockroaches and ev- 
erything else. I don't know an3^hing about them but I do know the 
difference between chickens and human beings. These are the kind 
of things we deal with. They come from the best interests of people 
who are deeply concerned but there isn't a single one of us in this 
room that isn't a deeply caring person or less caring than somebody 
else or you on that panel. 

So I have one thing for the record because I see the Internet is 
all clogged up on how to send a letter to Congress. I once saw one 
that said 60,000 people are on the Persian Gulf Registry. That is 
correct, but I want the record to show that 12 percent of the reg- 
istry participants report no current health complaints of any kind. 
None. Somebody ought to pick that up. We won't ever read it in 
the paper or hear it on television. I can assure you. But 7,200 peo- 
ple on the 60,000-registry of human beings are saying there's noth- 
ing wrong with them at all. Yet I read this sample letter to Mem- 
bers of Congress circulating on the Internet. It says, 
". . . approximately 60,000 American soldiers who served in the 
Gulf War have claimed they may be ill due to various chemical and 
biological exposures. . . " unquote. That is not true. I deal with a 
lot of stuff as Chairman of this Committee that isn't true. 

So I am going on to Harvard. My God, that will be a marvelous 
experience. 

I can just say that if anyone can show me that there are hun- 
dreds or thousands of human beings in this country, especially vet- 
erans, who are not being cared for, then I'm going to refer them 
to this man right here. Dr. Kizer. To me he holds the promise of 
doing the most extraordinary job that I have ever seen pursued in 
his work. I commend him. He is the most able VA spokesman dur- 
ing my tenure because he doesn't mess around. He lays it out. The 
veterans service organizations go goofy sometimes, and the sci- 
entists go goofy sometimes, and I go goofy sometimes, but he 
doesn't. I commend him. So if anyone writes to the panel or if we 
hear from somebody again about what are we doing for the veter- 
ans of the United States, tell them, "Everything a caring nation 
can do." We're continuing to do it. What we're doing for the Gulf 
War veterans is extraordinary, and what we did for the Vietnam 
veterans would fill books compared to what we did for the World 
War I veterans. We just let them die out. And the World War II 
veterans — we've taken care of them as best we can. 

So that's my swan song, and I want to thank you. It's been a 
good run, and I admire you all greatly. I admire Senator Rocke- 



56 

feller. He feels passionate about these things. I don't share his pas- 
sion at all. Senator Specter will be just as passionate. You'll hear 
about his father Harry. I've heard that. He must have been a won- 
derful guy. I tell him about my father Milward who was a member 
of the Army in the First World War. I commend them and wish 
them well. God Speed. 

Thank you very much. 

SSCI Chairman Specter. Thank you very much, Senator Simp- 
son. It's not possible to top Senator Simpson, so I shall not say 
much. 

We'll be visiting this subject in the future, beyond any question, 
and my hope would be that we move ahead to get conclusions very, 
very promptly. I would have preferred. Dr. Joseph, to have heard 
some responses as to the question put by some of the doctors even 
without peer review. It is a very different standard when you go 
into a court and you offer expert witnesses, and you have juries 
make conclusions, contrasted with the sovereign immunity which 
the Government of the United States has — for good reason — but we 
have to move ahead. 

And when you were asked the question — after saying we found 
out about it in June of this year — could we have found out about 
it sooner, you said, well, that's hard to say. I believe that the gov- 
ernment owes a very, very high duty to move ahead with speed, 
and to make the inquiries, and to find out before the government 
is pressed. But we will revisit this in some substantial detail, and 
we'll miss Senator Simpson. 

I would ask unanimous consent, that without objection, the letter 
from Deputy Secretary White dated today, to Senator Thurmond 
will be made a part of the record in conclusion, and the New York 
Times article of September 6, 1996. 

[The letter and the article referred to follow:] 

Deputy Secretary of Defense, 
Washington, DC, September 25, 1996. 
Hon. Strom Thurmond, 

Chairman, Senate Armed Services Committee, 
U.S. Senate, Washington, DC. 

Dear Mr. Chairman: The Department of Defense continues to investigate vigor- 
ously matters relevant to the illnesses of Persian Gulf War veterans. I want to re- 
port to you on the status of our current efforts, and to apprise you of the fact that 
we are redoubling our efforts, broadening the scope of our investigations and adding 
additional resources to the effort in light of several recent developments. 

At the end of the Gulf War, American troops moved rapidly through Iraq destroy- 
ing ammunition storage facilities. At one of these facilities, Khamisiyah, we have 
learned that U.S. troops destroyed chemical munitions on two separate occasions. 
The troops were unaware of this at the time. At this time, we do not know if U.S. 
troops were exposed to toxic chemicals during these events, but this new informa- 
tion requires more research and a vigorous investigation. We must now broaden our 
efforts and intensify our focus on the possibility of low-level exposures of U.S. 
troops. 

We are making every effort to contact individuals who were present at the site 
and to enroll them in our clinical evaluation programs. We remain committed to the 
care and welfare of our active duty personnel and of our veterans. 

In light of these developments, I am today initiating a number of immediate and 
longer-term actions with regard to the Department's efforts concerning sponsored 
medical research, clinical evaluations, document review and declassification, and in- 
vestigations of specific incidents. These efforts include: 

Forming an Action Team to completely reassess all aspects of our program. This 
team will report directly to me. 



57 

Drawing on additional outside analj^ical and management resources to help in 
the reassessment because the new information demands new and different exper- 
tise. 

In addition to the reassessment, I am directing the following specific initiatives 
immediately: 

1. DoD-sponsored research into the possible effects of low-level chemical exposure 
will total $5 million. In addition, I am directing the Assistant Secretary of Defense 
for Health Affairs to explore further research projects in this area where additional 
resources could be usefully applied. 

2. Our clinical investigation efforts will be broadened, in an effort to include per- 
sonnel in the area of potential exposure around Khamisiyah in our comprehensive 
clinical evaluation program. 

3. The Department of Defense will ask the Institute of Medicine to re-validate 
DoD clinical protocols and practices in light of possible low-level exposure. 

4. The Secretary of the Army has been directed to instruct the Army Inspector 
General to conduct an inquiry into the events surrounding the destruction of the 
munitions at Khamisiyah and supplement the efforts of the DoD Persian Gulf Inves- 
tigation Team where possible. 

5. The Assistant to the Secretary of Defense for Intelligence Oversight will inves- 
tigate and report to me on the information received by the government pertaining 
to Khamisiyah in 1991 and any other related intelligence information and to report 
on the procedures by which this information was handled. 

6. The Interagency Security Classification Appeals Panel (ISCAP) has been asked 
to undertake an objective review of the process and guidelines by which documents 
are declassified and placed on GULFLINK and to provide recommendations regard- 
ing this process. 

This Administration, and Secretary Perry and I personally, remain committed to 
a full effort to understand Persian Gulf War Veterans illnesses and to provide all 
necessary medical care. We will keep you apprised of our efforts in this area. Thank 
you for your support. 



[From The New York Times, Sept. 6, 1996, Friday, Late Edition— Final] 

Presidential Panel Says Pentagon Lacks Credibility for Inquiry on Nerve 

Gas Exposure 

(By Philip Shenon) 

Investigators for a Presidential advisory committee said today that the credibility 
of the Defense Department had been "gravely undermined" by its inquiry into the 
possible exposure of American troops to Iraqi chemical weapons during the 1991 
gulf war. They recommended that the investigation be taken away from the Penta- 
gon and handed over to an outside body. 

The investigators also concluded that as many as 1,000 American troops — more 
than double the number that had been originally reported by the Pentagon — were 
exposed to sarin, a deadly nerve gas, when a battalion of American combat engi- 
neers blew up an Iraqi ammunition depot in March 1991. 

"The Department of Defense has conducted a superficial investigation of possible 
chemical and biological agent exposures which is unlikely to provide credible an- 
swers to veterans' questions," the investigators said in a statement presented today 
to the Presidential Advisory Committee on Gulf War Veterans' Illnesses, a panel 
created last year by President Clinton. "A credible review of these allegations and 
concerns cannot be accomplished by the Department of Defense." 

The findings by the investigators, who work for the 12-member committee ap- 
pointed by the Wliite House, were an indictment of the leadership of the Pentagon, 
which until this year had insisted publicly that it had no evidence that large num- 
bers of American soldiers had been exposed to chemical or biological weapons de- 
spite reports of mysterious, debilitating illnesses among thousands of gulf war veter- 
ans. 

The Defense Department defended its investigation of the issue, with its senior 
health officer, Stephen C. Joseph, telling the panel at a public hearing today that 
the Pentagon's internal inquiry into gulf war illnesses had been "a major contribu- 
tion to the department and, we would suggest, to the public." 

The investigators' findings have not been formally adopted by the panel — that is 
expected to happen late this year, as the panel completes its final report — but there 
was no substantive criticism of the findings when they were discussed in today's 
hearing. 



58 

The panel is led by Joyce C. Lashof, a physician who is the former president of 
the American Public Health Association, and includes several other prominent sci- 
entists and researchers. 

'The Department of Defense's official position has remained essentially un- 
changed, and that can be summarized as the three no's — there was no use, there 
was no exposure, there was no presence," the committee's chief investigator, James 
Turner, told the panel at the hearing. 

'The inflexible reassertion of this position in the face of growing evidence that 
there were possible low-level exposures — there were chemical munitions in the Ku- 
waiti theater of operation, there were releases — have served to gravely undermine 
the credibility of the Department of Defense's internal investigation." 

He said that the Pentagon team in charge of the investigation had spent too much 
time on scientific research that would be "more appropriately delegated to other 
components of the Department of Defense" and too little time in studying intel- 
ligence reports and combat logs, and in interviewing veterans who said they had 
evidence that chemical and biological agents were released. 

A member of the panel, Andrea Kidd Taylor, an occupational health consultant, 
said the Pentagon's handling of the issue had created "the feeling of cover-up, even 
if there isn't any cover-up." 

In testimony before the committee. Dr. Joseph, the Assistant Secretary of Defense 
for Health Aff'airs, rejected the criticism of the Pentagon's investigation, and sug- 
gested that the internal inquiry would continue despite the recommendation today 
that it be handed over to an outside body. 

"While we are always open to constructive criticism, let me respectfully suggest 
that this concern fails to recognize and appreciate the department's complete com- 
mitment to investigating the possible causes of Persian Gulf illnesses in the context 
of its support for all gulf war veterans," he said. 

Still, Dr. Joseph said that the Pentagon was willing to consider new methods of 
investigating the issue "if together we can work out an alternative rule of thumb 
for which things we should look at." 

The Defense Department's credibility on the issue has been shaken in recent 
weeks, especially after the disclosure in June that a group of American conbat engi- 
neers may have been exposed to nerve gas and mustard gas when they blew up the 
Kamisiyah ammunition depot in southern Iraq in March 1991. 

Pentagon officials initially said they had no conclusive evidence that any Amer- 
ican soldiers had been exposed to chemical weapons at the depot but that 300 to 
400 troops had been in the vicinity at the time of the explosion. 

But based on evidence compiled by the Central Intelligence Agency, investigators 
working for the Presidential advisory committee said today that the number of 
troops who might have been exposed to nerve gas was actually about 1,100. And 
they reported that the evidence of the release of chemical agents at Kamisiyah was 
"overwhelming" and that "exposure to troops within 25 kilometers of the demolition 
activity should be presumed." 

Despite the Pentagon's repeated assertion that it had no evidence that American 
soldiers had been exposed to Iraqi chemical weapons, a long-classified intelligence 
report made public last week showed that senior officials at the White House, the 
Pentagon, the Central Intelligence Agency and the State Department were informed 
in November 1991, eight months after the demolition, that chemical weapons had 
been stored at Kamisiyah. 

Dr. Joseph said today that it was not surprising that the reports were overlooked 
in 1991 since at that time, "no one was thinJdng about a large number of our armed 
forces coming back and complaining of symptoms and illnesses following their serv- 
ice in the gulf war." 

Mr. Turner, the panel's chief investigator, was also critical of the Pentagon's 
"slow, reluctant, on-again, off-again release of information to the public." He said 
that it had "served to also undermine credible confidence in the Department of De- 
fense's efforts." 

James J. Tuite 3d, a former Congressional investigator who is the founder of the 
Gulf War Research Foundation and has emerged as a chief critic of the Pentagon 
on the issue, welcomed today's findings. He described the Defense Department's in- 
vestigation of gulf war illnesses as "dishonest and irresponsible" and said that it 
had been influenced by a "vested interest in the outcome of the investigation." 

SSCI Chairman SPECTER. We thank you, Mr. McLaughHn. I note 
that you've been accompanied here today by Ms. Sylvia Copeland, 
who is chief, Gulf War Illness Task Force. We thank you, Dr. Jo- 
seph, for your service. Most of the questions were directed at you 



59 



because essentially, it is the Department of Defense response that 
we need. We thank Dr. Kizer, and note that he's been accompanied 
by Dr. Francis Murphy, Director of the Environmental Agents 
Service, Department of Veteran Affairs. 

That concludes our hearing. Thank you all very much. 

[Thereupon, at 1:12 o'clock p.m., the hearing was concluded.] 



60 




CIA Report on Intelligence Related to 
Gulf War Illnesses 



2 Ausust 1 996 



61 



CL\ Report on Intelligence Related to 
Gulf War Illnesses 



Key Findings: 

On the basis of a comprehensive renew of intelligence and other information, we assess 
that Iraq did not use chemical or biological weapons or deploy these weapons in Kuwait 
In addition, analysis and computer modeling mdicate chemic^ agents released by aerial 
bombing of chemical warfare facilities did not reach US troops in Saudi Arabia. Coalition 
bombmg resulted m damage to filled chemical munitions at only two facilities- 
Muhammadiyat and Al Muthanna-both located m remote areas west of Baghdad. 
UNSCOM inspections concluded that no chemical munitions were destroyed at the An 
Nasinyah Ammumtion Storage Area, countering publicized theories that fallout from the 
facility were the cause of credible but unverified nerve agent detections in Saudi Arabia. 
We assess no biological weapons or agents were destroyed by Coalition forces dunng the 
Gulf war. Finally, Iraq never produced radiological weapons for use and bombed Iraqi 
nuclear facilities caused only local contamination north of the Kuwait Theater of 
Operations. 

A recent assessment based on a comprehensive review of all intelligence information and a 
May 1996 UNSCOM inspection concludes nerve agent was released as a result of 
inadvertent US postwar demolition of chemical rockets at a bunker and probably at a pit 
area at the Khamisiyah Ammunition Storage Area in Iraq. We have modeled the chemical 
contamination levels in Iraq resulting from the bunker destruction so that the DOD can 
assess who may have been exposed. Analysis of demoUtion activities in the pit area is still 
under way. 



40-180 97 - 3 



62 



Contents 



Page 



Key Findings iii 

No Intentional Iraqi Use of Chemical or Biological Agents I 

Chenucal Weapons at Two Southern Iraq Depots: An Nasiriyah and Khamisiyah 1 

An Nasinyah; Chemical Muniuons Moved to Khamisiyah 1 

Khamisiyah; Some Chemical Mumtions Destroyed by Groimd Troops 2 

Bunker 73 Rocket Destrucuon 3 

Pit Area Rocket Destruction 3 

Open- Area Mustard Shells Intact 3 

Modeling ot Release of Agents From Bunker 73 4 

Chemical Fallout From Aenal Bombing: At Muhammadiyal and Al Muthanna 5 

Muhammadiyat 5 

Al Muthanna 7 

No Evidence of Biological Fallout From Aerial Bombing 7 

Iraqi Chemical and Biological Agents 7 

Other Potential Hazards 8 

Red Funning Nitric Acid (RFNA) 8 

Radiological Weapons and Radiation Fallout 8 

Miscellaneous 8 

Future Efforts 8 

Text Box 

Modeling Assumptions About Bunker 73 4 

Table 

Selected Suspea Chemical Weapons Sites Examined 6 



63 



CL\ Report on Intelligence Related to 
Gulf War Illnesses 



No Intentional Iraqi Use of Chemical or Biological Agents 

We assess that Iraq did not use chemical or biological weapons against Coaliuon troops based on our 
thorough review ot intelligence reporting and on the lack of casualaes that was a signature ot chemical 
use dunng the Iran-Iraq war. We assess that Iraq probably did not use these weapons because of a 
perceived threat of overwhelming Coalmen retaliation. 

Chemical Weapons at Two Southern Iraq Depots: An Nasiriyah and Khamisiyah 

We assess that Iraq had chemical weapons at two sites (see figure 1) m Iraq-ihe An Nasinyah 
Ammuniuon Storage Depot SW and the Khamisiyah (US name Tall al Lahm) Ammunition Storage Area- 
within the Kuwait Theater of Operauons (KTO)' during Desert Storm. Both of these sites were large 
rear-area depots near the northern boundary of the KTO that stored mostly convenuonal ammuniaon. 
UNSCOM reporting and other informauon mdicate that Coaliuon bombing did not destroy the bunker 
containing the chemical agents temporanly stored at An Nasinyah. We have recently determmed US 
troops were near a release of chemical agents at Khamisiyah, and DOD is assessing potential exposure. 

An Nasiriyah: Chemical Munitions Moved to Khamisiyah 

According to Iraqi statements to LT^ISCOM in May 1996, An Nasiriyah stored 6,000 155-mm mustard 
rounds from early January until they were moved to Khamisiyah after 15 February 1991. Iraq stored the 
muniuons starting just before the air war at one bunker-called Bunker 8 by Iraq-at An Nasinyah 
Ammunition Storage Area SW. According to Iraq, these mustard rounds were moved to Khamisiyah 
because of fear of addiuonal Coalition bombmg. 

The Coahuon bombing of An Nasinyah on 17 January 1991 did not cause a release of chemical agent 
because the bunkers that were bombed on that date did not contam chemical agents. In May 1996. 
UNSCOM inspectors examined the rubble surrounding the bunkers at An Nasinyah that were bombed on 



' Generally defined as Kuwait and Iraq below 31 degrees north latitude." 



64 



17 Januarv' 1991 and Jetennuied thai the bunkers contained only convenaonal weapons AlLbous^h 
mustard rounds uere in Bunker 8 at An Nasinyah on 17 Januar\-, UNSCOM infonnauon indicates they 
were not damaged. No other agents were known to he at An Nasinvah. 

Khamisiyah: Some Chemical Muxutions Destroyed by Ground Troops 

L'NSCOM mspected chemical muniuons at or near Khamisiyah in October 1991 and idenufied i;2-mm 
sann/cyclo-sann (GB/GF) nerve-agent-filled rockets and 155-iiun mustard rounds. At that tume it was not 
clear whether these chemical weapons had been present dunng the Gulf war or whether, as was suspected 
at other iocauons, the Iraqis moved the muniuons there shortly before the 1991 UNSCOM inspecuon. 

Dunng Its October 1991 inspecuon of the Khamisiyah facility, the Iraqis told UNSCOM thai Coahuon 
troops had desaoyed chemical weapons at a bunker earlier that year, and L^SCOM found chemical 
muniuons at two open sues (see figure 2); 

• Remnants of 122-irun rockets were idenufied at a single bunker among 100 bunkers, called "Bunker 
73" by Iraq. It was unclear whether the muniuons in Bunker 73 were chemical because there was no 
samplmg or posiuve chemical agent monitors (CAM) readings and inspectors did not document 
characiensuc features of chemical muniuons. 

• Several hundred mostly intact 122-mm rockets containmg nerve agent-detected by sampling and with 
C.\Ms-were found at a pa area about 1 km south of the mam storage area. 

• Over 6.000 intact 155-mm rounds containing mustard agent, as indicated by CAMs, were found in an 
open area several kilometers west of Khamisiyah. 



" This sutement. however, was viewed with skepticism at the tune because of the broad, continuous use of deception 
by the Iraqis against UNSCOM. 



65 



Fi«^ure 1. Iraq's Declared Wartime CAN Agent Stockpile 





AIMawsil 1 IX i-i v*c 

• 


Al Muthanna 




Saddam Airbase 
Al Tuz Airfield 
\ Al Bakr Airbase 


Al Qadisiyah 
Airbase 




• ▼Dujayl 




/ 


\^*Baghdad 


Muhammadiyat 


\^^" — Tammuz Airbase 


• # 




^ — Fallujah Proving 
Ground 

An Nasiriyah' 

— \, _ - 3r N 






Khamisiyah / • 
m^ ^ Al Basrah 



Munition Types: 

A = Artillery Shells 
= Bombs 
Y - Missile Warheads 
■ = Artillery Rockets 
^ = None (Bulk Storage) 



CW Agents: 

= Mustard (Undamaged) 

■ = Mustard (Damaged) 

■ = Sann/GF (Undamaged) 

■ = Sarin/GF (Damaged) 



'Moved to Khamisiyah after 15 February 1991 



GWC'/V 01-796 



66 



Kiyure 2. Khamisivah Ammunition Storage Area 

39 4tt: 41 




67 



Bunker 73 Rocket Destruction. The recent comprehensive review of all informauon enabled us to 

determine that L'S troops-not Iraq-destroyed the rockets in Bunker 73. In March 1996. in conjuncuon 
with DOD uivesucaiors. we determined that the US 37th Engineenng Battalion had destroyed that bunker 
along with over 30 other bunkers on 4 March 1991. 

However, it was not until L'NSCOM's May 1996 inspecuon at Khamisiyah that it was deieniuned that 
Bunker 73 contained remnants of 122-mm chemical rockets. Dunng this inspecuon, inspectors 
documented the presence of high-density polyethylene mserts, burster tubes, fill plugs, and other features 
charactensuc of Iraqi chemical muniuons. Analysis of the contents of the rockets that UNSCOM found in 
1991 in the pit area just outside the Khamisiyah Storage Area shows that the idenucal rockets in Bunker 
73 had been filled with a combinauon of the agents sann and GF. Therefore, we conclude that US troops 
destroyed chemical rockets m Bunker 73. 

Pit Area Rocket Destruction. Dunng the May 1996 UNSCOM inspection, Iraq claimed that some of the 
rockets located m the pit area had been destroyed by occupying forces. On the basis of very recent 
mterviews of 37th Engineenng Battalion personnel, DOD now believes that demolition personnel did set 
charges on stacks of rockets m the pa on 10 March 1991 at 1630 local time. 

We are sull trying to deiermme the number of rockets US forces could have destroyed. Once we 
determine the number, we will model the likely hazardous area caused by the destruction. Iraq told the 
May 1996 UNSCOM inspectors that it moved about 1,100 rockets out of Bunker 73 to the pit 2 km away 
to avoid chemical contamination of the bunker facility. The Iraqis claimed the rockets started leaking 
unmediately after they were transferred from the Al Muthanna CW Production and Storage Facility just 
before the air war. 

Open-Area Mustard Shells Intact As discussed previously, more than 6,000 mustard rounds were 
moved from An Nasinyah to an open area several kilometers west of the main facility at Khamisiyah. 
These munitions were found undamaged by UNSCOM in October 1991. They were later moved to and 
destroyed at UNSCOM's Al Muthanna destrucuon facility. 



68 



Modeling of Release of Agents From Bunker 73 

Modelin^j ot [he potenLuJ hazard caused by destruction of Bunker "? indicates that an area around the 
bunker at leait 2 km in all direcuons and 4 km downwind could have been contaminaied at or above the 
level tor causing acute sv-mptoms including runny nose, headache, and miosis (see figure 3 and text box). 
.\n area up to 25 km downw uid and 8 km wide could have been contaminated at or above the much lower 
general populaaon dosage limit. From wind models and observaaons of a video of destrucuon activitv at 
Khamisiyah. we deiermmed that the downwind direction was northeast to east (see figure 4). 



Modeling .Assumptions .\bout Bunker 73 

Some ot ihe following modeling assompaons were based on data from US testing m 1966 that mvolved descrucnon of 
a bunker filled with 1 .850 GB rockets with maximum range similar to that of Iraqi rockets found in Bunker 73: 

• 1.060 rockets is indicated by Iraq. 

• Rockets tilled uith 8 kg of a 2. 1 ratio of GB to GF (contents assumed to be 100 percent agent) based on 
UNSCOM mformatjon and sampling from the pit. 

• Ten percent of rockets ejected from the bunker, half of which randomly fall within a 200-meter circle, the other 
half fallmg withm a 2km cu-cle based on US tesnng ' 

• Ejected rockets released agents on impact. 

• A 15 -meter mean agent release height was chosen to be conservauve when determining ground hazard. 

• .AJl but 2.5 percent of agent in the bunker degraded by heat from explosion and motor/crate burning based on US 
tests. 

• Wmds slow to the northeast to east, based on modelmg and analysis of a videotape of the destrucaon acUvity at 
Khamisiyah. 

• Our models do not include the effect of the reported 32 to 37 convenuonal ordnance bunkers detonating and 
burning simultaneously with the chemical bunker. The added thermal energy created by explosions and fires m 
the other bunkers and solar heating caused by the mcreased amounts of smoke would tend to degrade agent as 
well as more qiuckly disperse the agent between the ground up to the maximum altitude of 800 to 1.200 meters *' 
This more rapid vertical spreading would tend to lower ground contamination in the area. 

DOD dociunents and mulople veterans reported thai munition "cook-offs"-nxuniQoiis that ignite and are ejected froin their storage due to 
Ihe demoliuoQ fire-sent ordnance as far as 10 km or more from ihe bunker faality. Nonetheless, we did not model this phenomena 
because we have been unable lo detennine whether any of the cook-ofis involved chemical rockets, and tf so. the aumber of rockets and 
how far they went 

This alutude represents the estimated height of the mixing layer-the lower luibuJent part of the aunosphere above whidi agent transport 
IS inhibited due to a laminar boundary layer. This layer can often be seen from aircraft while landing in aues with polluted air. 



The Army estabUshed this dosage cntena for protection of the general population: a 72-hour exposure at 
000003 mg/m3-signLficanlly lower than the 0001mg/m3 occupational limit defined for 8 hours-is specified. 



69 



Fisiure 3. 6.4-\letric-T()n Rele;ise of Sarin at khamisivah Storage Area. 
Bunker 73 on 4 March 1991 ( 1 1(X)Z) 



vt"^-^'^^^ /^ 


^1*^"^ ■■ 




[.'■ -■ 


';,3j>< 


T^ 


^s 


_4('' — / 


^^ 


L ^ 


%=^ 


,475 : 


-v^^ 


\VJIJ 




.^K^^Ki '^.Mr'rif W ^ 


C^«. 


;- 


"""^8 


t— — __. 






H^BHH 


1^ 


fe^ 


U:p.*w 


PU 


cr j 


^^=.,20^ 
Kilometa^^^ 


..] 


' v-^/ 


^ ^''rf^- 




^jg 



I 



Lethal 

Incapacitated/Disabled 

Vision Impaired 
(Miosis) 

First Effects '* 

(Runny nose, watery eyes) 

8-Hour Occupational Umit 
(0.048 mg-min/m3) 

72-Hour General Population Limit 
(0 013 mg-min/m3) 



First effects also may include tightness of chest, 
coughing, skin twitching, sweating, and headache 



2.5% Effective Release, 
fVlean Cloud Height 15 Meters 



I R AQ 



Khamisjyah< 



70 



j-iuure 4. Determining NN ind Direction Durintj Demolition of Bunker 1} at Khamisi\ah 



Video Camera 
Vantage Point 



U'<: 



At 1405 on 7 March 91 
at Khamisiyah 
Sun Azimuth = 196' 
Sun Elevation = 52" 



Apparent Wind Direction 
Based on Smoke Drift 




• Shadows fall and snnoke drifts roughly to the viewer's left 
in the video. On the basis of sun angles, this puts the wind 
direction in the northeast quadrant and puts the viewer 
roughly to the northwest. 



71 



Chemical FaJIout From Aerial Bombing: At Muhammadiyat and Al Muthanna 

We conclude Lhat Coalition aenal bombing damaged filled chemical muniaons at two facibtjes- 
Muhammadiyat and .AJ Muthanna. In reaching this assessment, we examined all intelligence 
reporung on the locauon of chemical weapons in Iraq and the KTO and scruunized dozens of sites 
I see table) lhat uere alleged to be connected m one way or another with chemical weapons. Our 
modeling indicates that chemical agent fallout from these faciUties-both located in remote areas west 
of Baghdad-did not reach troops m Saudi Arabia. Finally, we have found no information to suggest 
that casualties occurred mside Iraq as a result of chemical warfare (CW) agents released from the 
bombing of these sites-probably because these two facilmes are m remote locauons far from any 
populauon centers. The Muhammadiyat and Al Muthanna sites are both over 30 km from the 
nearest Iraqi towns. 

According to the most recent Iraqi declarauons, less than 5 percent of Iraq's approximately 700 
metric tons of declared chemical agent stockpile was destroyed by Coaliuon bombing. In most cases, 
the Iraqis did not store CW munitions m bunkers that they believed the CoaUuon would target The 
Iraqis stored many CW munitions m the open, protecung them from Coaliuon detecuon and 
bombing because we did not target open areas. In addiaon, all known CW and precursor producuon 
Imes were either inactive or had been dismantled by the start of the air campaign. 

Muhammadiyat 

Iraq declared that 200 mustard-filled and 12 sarin-fiUed aenal bombs at the Muhammadiyat (US 
geographic name Qubaysah) Storage Area were damaged or destroyed by Coaliuon bombmg. We 
have modeled the contaminated area resulting from bombing of Muhammadiyat, a site at least 410 
km from US troops stationed at Rafha and even further from the bulk of US troops (see figure 5). 
Bombing of this facility began on 19 January and contmued throughout the air war. We have been 
unable to determine exactly when the chemical bombs were destroyed. On the basis of recent Iraqi 
declarauons, we have modeled a release of 2.9 metnc tons of sarin and 15 metric tons of mustard on 
all possible bombing dates to find the largest most southerly hazardous area. Southerly winds 
occurred for only a few of the days the site was bombed. Figures 6 and 7 show that for general 
population limit dosages (above 0.013 mg-min/m3), downwind dispersions in the general southerly 
direcuon for sarin and mustard fall below this level at about 300 and 130 km. respecuvely. 



72 



Selected Suspect Chenucal Weapons Sites Examined' 



Facilities 

.AJ Muthanna (Samarra) 

KiamiMvah iTaJl aJ Lahmi 

Muhammadiyai (Qubaysah Storage Depot) 

AJ Wahd .Airbase i H3 .Airfield) 

FaJluiah I iHabbaniyah III) 

Fallujah III iHabbaniyah I) 

M Bakr Airfield [subordinate] (Samana East .Airfield) 

.Al Taba'ai .Airstnp (H3 SW .Aorfield) 

.Al Tuz Airfield (Tuz Khunnatu Airfield) 

Dujayl/Awarah (Sumaykab SSM Suppon Facdiry SE) 

Falluiah Chem Proving Gnd (Habbaniyah CW Training Center) 

Murasana Airbase (H3 NTW' Airfield) 

Qadisiyah .Airbase <.A1 ,Asad .Airfield) 

Saddam .Airbase iQayyarah West Airfield) 

Tanunuz .\irbase i.AI Taqaddum Airfield) 

Al Qaim Superphosphate Fertilizer Plant 

Al Taqaddum .Airfield 

An Nasinyah Ammo Storage Depot SW 

Ash Shuaybah .Ammo Storage Depot 

Baghdad Ammo Depot Taji 

Fallujah II (Habbaniyah 11) 

K-2 Airfield 

Kirkuk .Airfield 

Kirkuk Ammo Depot West 

Mosul Airfield 

Qayyarah West Airfield 

Qayyarah West Ammo Storage Depot 

Tallil Airfield 

Ubaydah Bin al Jarrah Airfield 

Ad Diwaniyah .Ammo Depot 

Al Fallujah Ammo Depot South 

Ukhaider (Karbala Depot and Ammo Storage) 

Qabauyah Ammo Storage fWadi al Jassiyah Ammo Storage) 

Tiknt Ammo Depot (Salahadin) 



Coordinates 

3351N/04349E 

3045N/04623E 

3315N704:41E 

3;56N/03945E 

3329N704349E 

3333N/04338E 

341 ON/044 16E 

3245N/03936E 

3457N704428E 

3349N/04415E 

3308N/04352E 

3305N/03936E 

3347N/04226E 

3546N/04307E 

3320N704336E 

3422N/O41I0E 

3320N/O4336E 

3058N/04611E 

3029N/O4739E 

3333N/04414E 

3329N/04340E 

3455N/04605E 

3528N/04421E 

3533N/04358E 

36I8N/04309E 

3546N/04307E 

3552N/04307E 

3056N/04605E 

3229N704546E 

3158N/04454E 

3313N/04341E 

3223N/04330E 

3352N/04242E 

3443N/04339E 



These sites represent examples of sites that have been connected-often tenuously-to Iraq s chemical warfare 
program. 



73 



Figure 5. 


Iraqi Facilities With Damaged Chemical-Agent 


-Filled Munitions 




■ 

IRAQ 




Al Mawsil 




i 
i 


• 




i 


Al Muthanna 






.. .- .. 4^80 km 
MuhammadiyatA / ^^ 






T / Baghdad 




i 

[ 


410 km\ /470 km 




i 


\ / KhamisiyahA 


• 
Al Basrah 




Rafha* 


KUWAIT 

• 
Kuwait City 


i 


KKMC* 




1 



GWCW03-7 96 



40-180 97-4 



74 



Figure 6. Worst C ase Ma/ard Footprint for 2.9-Metric-Ton Sarin Release 
at Mijhammadi>at Storage \rea 


IRAQ 


Al Mawsil 

• 1 

1 

1 


! 
Al Muthanna 


▲ 


Muhammadiyat A 


\ ""^ 


\ 

10% Effective Release: KhamisiyahA 

Mean Cloud Height 15 Meters • 


A[Basrah 


Rafha» ^^j^^,^ 


• 


First Effects '* Kuwait City 
(Runny nose, watery eyes) 

1 


! 8-Hour Occupational Limit KKMC» 
I (0.048 mg-min/m3) 


72-Hour General Population Limit 
1 (0.013 mg-min/m3) 


" First effects also may include tightness of chest, 
coughing, skin twitching, sweating, and headache 


Scale 1 inch = 160 km % 





Gwcw :5-:96 



75 



Figure 7. Worst C ase Hazard Footprint for 15.2-Metric-Ton Mustard 
Release at Muhammadi\at Storage Area 


1 R AQ 

Al Mawsil 

• 


aAI Muthanna 
i Muhammadiyat . 


X Baghdad 

1 
i 


1 

! 10% Effective Release: KhamisiyahA 
Mean Cloud Height 15 Meters • 


Aj Basrah 


Rafha» ^^j^^,^ 


• 


First Effects " Kuwait City 
(Runny nose, watery eyes) 


i 8-Hour Occupational Limit KKMC« 
i (0.048 mg-min/m3) 


72-Hour General Population Limit 
(0.013 mg-min/m3) 


" First effects also may include tightness of chest, 
coughing, skin t^A/ltchlng, sweating, and headache 


i Scale 1 inch = 160 km 





GWCW 07.7 96 



76 



Neither the first effects nor the general populauon limit levels would have reached US troops thai 
were siauoned in Saudi .Arabia.'' 

Al Muthanna 

Iraq Jeclared that 2.500 chemical rockets containing about 17 metnc ions of sarin nerve agent at .\1 
.\luihanna (US geographic name Samarra). the primary Iraqi CW producuon and storage facibty, had 
been destroyed by Coahuon bombing. LT^SCOM inspectors were unable to verify the exact number 
because of damage to the rockets. We have modeled possible bombing dates for this bunker and 
determined that the most southerly dispersal for reaching the general populauon limit dosage is 160 km 
( figures 8). well short of US troops. 

No Evidence of BiologicaJ Fallout From AeriaJ Bombing 

There are no indicauons that any biological agent was destroyed by CoaliUon bombing. Available 
intelligence reporung and Iraqi sutements indicate that Iraq went to great lengths to protect its 
biological muniuons from aenal bombardment. The Iraqis have stated that its biological-agent-filled 
aenal bombs were deployed to three airfields welJ north of the KTO. The bombs were placed m open 
pits far from bombing targets, then covered with canvas, and buned with dirt. Iraqi biological 
warheads for Al Husayn missiles were hidden well north of the KTO both m a railroad tunnel and in 
earth-covered pits al a locauon near the Tigris canal. The Iraqis admitted to production of biological 
agents at four sites near Baghdad but said it ceased producuon before the air war. In addition, 
UNSCOM found no damage to any of these faciliues from Coalmen bombmg. 

Iraqi Chemical and Biological Agents 

We found no evidence that would indicate that Iraq developed agents specifically intended to cause the 
most common types of long-term symptoms seen in lU Gulf war veterans. This finding is unporiani in 
rulmg out the scenano of covert use of such an agent With the possible exception of aflaioxm, all 
declared Iraqi agents were intended to cause rapid death or incapacitation. The only documented effects 
of aflaioxm in humans are liver cancer months to years after it is ingested and symploms-possibly 
mcluding death-caused by liver damage from ingestion of large amounts. Effects of aerosolized aflaioxm 
are unknown. UNSCOM assesses that Iraq looked at aflaioxm for its long-term carcmogemc effects and 



When predicting very low concentration levels far downrange of the source, large dispersions are created that are 
difficult to model. We assess, however, that our results are biased upward because we chose optimal times and dates 
that would have produced the maximum dispersion toward Saudi Arabia In addidon. the models do not account for 
phenomena-such as deposition onto the ground and rain removal of agent-that would grcady diminish potential 

downwind exposure. . 



77 



that tesung showed that large concentrauons of it caused death within days. We have no informauon that 
would make us conclude that Iraq used aflatoxin or that it was released in the atmosphere when bombing 

occurred. 

Other Potential Hazards 

CIA's also reviewed intelligence on potential hazards other than chemical and biological agents. Some ot 
the studied hazards include: 

• Red Fuming Suric Acid (RFS'A). Scud missiles that impacted m Saudi .\rabia and Israel each 
contamed approximately 300 pounds of toxic RFNA oxidizer and 100 pounds of kerosene fuel. 
.Although we know of no long-term illnesses related to these chemicals, we assess that RFNA is a 
likely cause of some of the bummg sensauons reported by veterans near Scud impacts. EXDD's 
Persian Gulf Invesugauon Team (PGIT) has been informed of this and is following up to look for 
long-term svinptoms. 

• Radiological Weapons and Radiation Fallout. Although Iraq conducted research on radiological 
weapons, we assess it never progressed into the developmental phase. Small quantities of radioacuve 
material were released during tests m areas north of Baghdad. These tests took place two years before 
the Gulf war, and any radioacuvity from those tests would have decayed away by the time of the war. 
In addition, Iraqi nuclear faaliues bombed during the Gulf war produced only minimal local 
contammauon north of the KTO, with no releases detected beyond those faciliaes. 

• Miscellaneous. We have seen a number of reports claimmg that veterans were exposed to other 
hazards including everything from poisoned water supplies to chocolate addiuves. In examming 
these reports, we found nothing to corroborate them, but we have made DODs Persian Gulf 
Investigative Team aware of them. 

Future Efforts 

CIA will continue to track any leads that surface in the future and will make our findings available to 
the public. We will complete our review of the hazards posed by destruction of chemical rockets m 
the pit area and will publish our findings over the Internet. 



78 




STATEMENT 



BY 



MATTHEW L. PUGLISI. ASSISTANT DIRECTOR 

NATIONAL VETERANS AFFAIRS AND REHABILITATION COMMISSION 

THE AMERICAN LEGION 



TO THE 



JOINT SENATE VETERANS' AFFAIRS COMMITTEE AND 

THE SENATE SELECT COMMITTEE ON INTELLIGENCE 

UNITED STATES SENATE 



ON 



REPORTS OF EXPOSURES OF US SOLDIERS TO CHEMICAL WARFARE 
AGENTS DURING THE PERSIAN GULF WAR 



SEPTEMBER 25, 1996 



79 



MATTHEW L. PUGLISI, ASSISTANT DIRECTOR 

NATIONAL VETERANS AFFAIRS AND REHABILITATION COMMISSION 

THE AMERICAN LEGION 

TO THE 

JOINT SENATE VETERANS' AFFAIRS COMMITTEE AND 

THE SENATE SELECT COMMITTEE ON INTELLIGENCE 

UNITED STATES SENATE 

ON 

REPORTS OF EXPOSURES OF US SOLDIERS TO CHEMICAL WARFARE 

AGENTS DURING THE PERSLVN GULF WAR 

SEPTEMBER 25, 1996 



Messrs. Chairmen and Distinguished Members of the Committees: 

The American Legion would like to take the opportunity to submit testimony concerning 
the exposure of US military personnel to low levels of chemical warfare agents during the 
Persian Gulf over five years ago. We will address the effects that the Department of 
Defense's inflexible policy concerning these exposures has had on the health care of ill 
Gulf War veterans, and the research of Gulf War illnesses. We would also like to propose 
a medical initiative that would address this issue in a manner consistent with the lessons 
learned from the experience of Vietnam veterans exposed to the herbicide Agent Orange. 

The American Legion realizes that today's hearing will focus on Defense Department and 
intelligence reports of exposure of US soliders to chemical agents during the Persian Gulf 
War. However, The American Legion would like to recommend that Congress address 
the inadequacy of the United States military's chemical and biological warfare agent 
detection and protection capabilities. This national security issue is extremely important to 
veterans' health issues, especially since DoD has been reluctant to address the 'gapping 
hole" in the nation's chemical and biological warfare defensive capabilities The American 
Legion is concerned because DoD continues to purchase and deploy protection and 
detection equipment which will not fiilly protect US military personnel from unhealthy low 
levels of chemical warfare agents. The inadequate chemical warfare protection and 
detection equipment is currently deployed with US forces in the Middle East, Korea and 
Bosnia were large stock piles of chemical warfare agents are known to exist. 

Over five years ago, while forcefully evicting the world's fourth largest army fi-om Kuwait, 
American troops were exposed to chemical warfare agents. The evidence of these 
exposures is overwhelming. DoD, however, continues to insist that American troops were 
not exposed to chemical warfare agents in the Persian Gulf 

The American Legion can only guess as to the reason for DoD's policy statements But 
we do not have to spend much time in determining the effects that DoD's policy has had 
on the heahh and well being of Gulf War veterans. 



80 



DoD's Comprehensive Clinical Evaluation Program (CCEP), a medical examination 
program for Gulf War veterans on active duty, diagnoses 18% of its participants with a 
psychological condition This can be compared with 7.1% of the general population who 
seek medical care in the United States (CCEP Report on 18,598 Participants, April 2, 
1996). Are we to believe that Gulf War veterans on active duty, after passing entrance 
physicals, psychological screenings, and deployment physicals, are over twice as likely to 
suffer from a psychological disorder as the average American civilian DoD has found an 
epidemic of psychological disorders in its ranks, an epidemic found only among those who 
come forward with health problems caused by their service in the Persian Gulf 

The group of psychological disorders most commonly diagnosed in the CCEP are 
Somatoform Disorders. According to the Diagnostic and Statistical Manual of Mental 
Disorders, Fourth Edition (American Psychiatric Association, Washington, DC, 1994), 
'the common feature of the Somatoform Disorders is the presence of physical symptoms 
that suggest a general medical condition, and are not flilly explained by a general medical 
condition [or] by the direct effects of a substance." (American Psychiatric Association, 
1994, p. 445) The American Legion believes DoD's policy on exposures has encouraged 
it's medical doctors to assign Somatoform Disorder diagnoses. One exposure that many 
Gulf War veterans claim to have encountered, chemical warfare agents, was not present in 
the Persian Gulf according to DoD The periodic pronouncements from DoD concerning 
the nonexistence of 'Gulf War syndrome," combined with it policy on exposures, has 
created an environment where DoD medical doctors believe that Somatoform Disorders 
are more common among Gulf War veterans. 

One illustrative example of the CCEP and DoD medical doctors' bias is that of a Gulf 
War veteran from Connecticut. This veteran was diagnosed with between nine and eleven 
diseases between 1991 and 1994 by the Army, and the Department of Veterans Affairs, 
after his service as a helicopter pilot during the Gulf War. Yet, when he underwent a 
CCEP examination during August of 1994, he was diagnosed with Somatization Disorder. 
That was his only diagnosis. This one example illustrates what DoD's own statistics 
demonstrate; the CCEP is biased against diagnosing disease in Gulf War veterans who 
suffer from poor health as a result of their service in the Persian Gulf 

DoD's policy has affected more than today's active duty servicemembers and veterans, 
and their treatment by DoD medical doctors. It has affected how Gulf War illnesses is 
being studied, the answers being sought, and our preparedness for future wars. 

Exposed to many environmental hazards in the Gulf to include: smoke from oil well fires; 
investigational medications, indigenous parasites; organophosphate pesticides, and stress, 
thousands of Gulf War veterans have complained of poor health since their return from the 
Gulf Their complex of health complaints has become popularly known as 'Gulf War 
syndrome." One, many or all of the environmental hazards American troops were exposed 
to in the Gulf could be the cause, of this illness, or illnesses. Dozens of well designed 
scientific studies are underway to determine the role of these hazards in Gulf War 



81 



illnesses. One environmental hazard, however, is not currently under study. That one 
hazard is low level chemical warfare agent exposure, its association with Gulf War 
illnesses, and with disease in general. It is not being studied because the Department of 
Defense has insisted that no American troops were exposed. 

Due to lack of coordination between the three federal agencies most responsible in 
determining the definition and etiology of Gulf War illnesses, DoD, VA and the 
Department of Health and Human Services created the Persian Gulf Veterans 
Coordinating Board. The Coordinating Board is responsible for selecting scientific studies 
that examine the relationship between service in the Persian Gulf and illness in Gulf War 
veterans. The Coordinating Board reviewed proposals this past winter, proposals fi-om 
respected scientists fi"om around the nation, who wanted to examine specific exposures to 
American troops in the Persian Gulf, and these exposures' association with disease. 
Proposals for studies examining low level exposures to chemical warfare agents and 
disease were not funded because DoD insisted that such exposures did not occur. We 
have now learned that Gulf War veterans were right all along, and that these exposures did 
occur. As of today, however, none of these studies are being funded, or are underway. 

DoD's position has also prevented the scientific study of this issue by the federal 
government The federal government is conducting dozens of scientific studies of its own 
that have been underway for over a year. None of these studies are examining the 
association between low level chemical warfare exposure and disease except one, and that 
is in spite of DoD's policy. 

In 1995, The Department of Veterans Affairs' Portland Environmental Hazards Center 
proposed to the Coordinating Board that it conduct a study examining the association 
between nerve agents and disease, but were dissuaded after the National Institutes of 
Health Panel, in 1994, concluded that such exposures did not occur. The NIH Panel 
based its conclusion solely on reports from DoD about such exposures. Today, we are all 
well aware of the credibility and validity of DoD's prior reports concerning these 
exposures. Portland did display some independence by choosing to study the association 
between mustard gas and disease because, they concluded, DoD could not detect it well 
with its equipment, and therefore, could not make reasonable claims that such exposures 
did not occur (Testimony of Dr. Peter S. Spencer, Ph.D., FRCPath, before the Presidential 
Advisory Committee on Gulf War Veterans' Illnesses in Boston, MA March 26, 1996). 

Clearly, DoD's inflexible policy concerning exposures has adversely affected the medical 
care of Gulf War veterans, and the scientific study of Gulf War illnesses. DoD coming 
forward with information it has possessed for over five years, after denying that this 
information existed, is shameful after one assesses the damage that their actions, or lack of 
action, has done. Worst of all, after determining that as many as 5,000 Gulf War veterans 
may have been exposed to chemical warfare agents near the Kamisiyah bunker alone, DoD 
proposes that these veterans seek CCEP examinations. These are the same exams that 
diagnose Gulf War veterans with psychological conditions at twice the national average. 



82 



Clearly, DoD's reaction to its recent admissions falls far short of the mark for Gulf War 
veterans. 

The American Legion does not offer this testimony merely to point out problems. We 
offer this testimony with a solution that will address this issue in a bold manner, based on 
sound science and medicine. We offer it in light of the lessons we all have learned from 
our experience with veterans exposed to Agent Orange. The American Legion proposes 
the following: 

1 . The Department of Veterans Affairs should collect tissue samples (blood and fatty 
tissue) from those believed to have been exposed to chemical warfare agents in the Persian 
Gulf Participation would be voluntary, however, it would be encouraged through 
extensive and comprehensive outreach. The tissue samples would be stored so that well 
designed studies could occur in the future to determine the existence of markers in those 
exposed to such agents. 

2. Congress should establish a commission to investigate American troops' exposure to 
chemical and biological warfare agents during or as a result of the Gulf War. This 
commission would also monitor the collection of tissue samples from those suspected of 
exposure, the storage of these samples, and the approval of any methods for examining 
these samples in the fiiture. 

This recommendation is consistent with the one offered to the Presidential Advisory 
Committee on Gulf War Veterans' Illnesses by its staff on September 5, 1996. The staff 
noted that DoD's policy and approach to chemical and biological warfare agent exposure 
in the Persian Gulf has so undermined its credibility that an independent commission 
should be created to investigate the issue. We recommend not only the creation of the 
commission, but that it oversee the tissue collection effort. 

Previous experience compels us to recommend the collection, storage and later re- 
examination of these tissue samples. Despite early, widely quoted negative scientific 
publications, retrospective estimates of exposure for both Ranch Hands and Vietnamese 
civilians correlated reasonably well with recently developed biological markers. Such 
markers and exposure estimates provide scientific strength to epidemiological studies, 
even though specimens were not collected until ten years later. These results raise the 
question whether biological specimens should be collected, stored, frozen in liquid 
nitrogen, under the assumption that biological markers will be determinable at some future 
date. 

Of importance to The American Legion, the federal government, and Gulf War veterans is 
the implication of improved exposure assessment. Because of the length of time since 
their most recent exposure, exposure assessment of Vietnam veterans will remain difficult: 
no tissue bank was established. This fact, and the recent scientific developments 
concerning the identification of biomarkers due to past exposure to chemicals makes the 
case that Gulf War veterans should have tissue and blood stored. This would allow at 



83 



some time in the future documentation or validation of exposure if a biological marker is 
identified. Early attempts at developing such markers are underway. Human subjects 
considerations become of great interest and may generate controversy. Stored samples of 
biological tissue may be examined for the substance of interest to exposure assessment 
but, at least theoretically, also for other substances such as drugs of abuse or for genetic 
testing. These latter two may generate appropriate concerns for protection of privacy. 
The commission proposed above would oversee the handling and testing of these samples, 
alleviating the privacy concerns of the participants. 

Tissue sampling will assess exposure levels without any smoke and mirrors from any 
group or federal agency. The federal government, and the Congress, want what is best for 
our veterans, while they wisely spend the taxpayers' money. Tissue sampling will one day 
help determine who was exposed to chemical warfare agents in the Persian Gulf, and at 
what levels they were exposed. In conjunction with well designed scientific studies that 
examine the relationship between low level exposure to chemical warfare agents and 
disease, we will be able to determine who fi-om the Gulf War was exposed, and know 
what effects that exposure has, or will have. We may also be able to treat these veterans 
at some future date based on this research. 

Looking to the future, we have not seen the last of American troops and chemical warfare 
agents. Unless the U.S. withdraws completely from the world, its troops will once again 
face an adversary armed with chemical warfare agents. Now is the time to address the 
lack of preparedness to fight such an adversary, and maintain the health of the troops that 
do the fighting. Congress has an opportunity to address future challenges to tomorrow's 
veterans, today. The American Legion encourages you to do so. 




84 



Department of Veterans Affairs 

Under Secretary r3H Health 
Washington DC 20420 



JAN 21 1997 

The Honorable Arleo Specter 

Chainnan. 

Committee on Vetcians' Affairs 

United States Senate 

Washington, DC 20510 

Dear Mr. Chairman 

I am writing in response to former Chairman Alan K, Simpson's October 28, 
1996, letter regardi]ig my appearance before the Senate Committee on Veterans' Affairs 
on September 25, 1996. As you requested, answers to the Committee's additional 
questions are provii led below. 

Question 1: The \'A set up the Persian Gnlf Registry to record the many ailments of 
Persian Golf War veterans. In your opinion, how well has the Registry helped the 
VA in its treatment of Persian Gulf War veterans? 

Response: U.S. troops retuming from Operations Desert Shield and Desert Storm began 
reporting a variety af illnesses which they initially attributed to inhalation of fijmes and 
smoke from burning Kuwaiti oil-weU fires. In August 1992, in response to these 
veterans' health coacems, VA initiated a health surveillance system, the Persian Gulf 
Registry Health Ex amination Program. 

The Persian Gulf Registry Health Examiaation Program offers a free, complete 
physical examination with basic laboratory studies to any Persian Gulf veterans. A 
complete medical liistory and interview are also performed and documented in the 
veteran's medical i-ecord. To date, more than 62,000 veterans have responded to VA's 
outreach encouraging them to participate. VA maintains a centralized registry, or list of 
participants who have had these examinations. This clinical database is called the Persian 
Gulf Veterans Health Registry. Specifically, the Registry: 

• allows VA to I cmmunicate with Persian Gulf veterans by informing them of new 
programs, research findings, or compensation policies through periodic newsletters; 

• helps VA respond to veteran's health concerns; 



85 



2. 

The Honorable Arlt o Specter 



• provides a surviiUajoce mechanism to catalogue prominent symptoms and diagnoses; 
and 

• allows VA to c< )iicentrate education eflforts on a special group of adroinistrative 
coordinators and Registry physicians. Each VA medical facility has a designated 
coordinator anci Registry physician who act as a source of information to veterans and 
other VA healtl icare providers. 

In sum, I believe it has been of substantial benefit to us in treating these veterans. 

Qaestion 2: Of the symptomatic Persian Calf veterans on the Registry, doyou 
know how many iire claiming their symptoms are related to low-level chemical 
exposores? 

Response: The se If-reported exposure history of 758 veterans on VA's Revised Persian 
Gulf Registry computer database shows 1 1% who rqjorted that they believed they had 
exposure to nerve :>as, 25% reported they had not been exposed to nerve gas, and 64% 
did not know if they had been exposed to nerve gas. Six percent of this group reported a 
beUef that they were exposed to mustard gas, 37% reported they had not been exposed to 
mustard gas, and 57% did not know if they had been exposed to mustard gas. "While the 
original registry c< )de sheet did not track veteran reported exposures, the revised 
questionnaire has i)een mailed to the approximately 53,000 veterans who received 
examinations prioi; to the revision. This information will be incorporated into the 
computerized database. 

Qaestion 3: The Department of Defense is developing a Geographic Information 
System (GIS). It will be a comprehensive registry of troop movement during the 
Persian GuIfWar. It win be an immensely important tool in identifying legitimate 
exposures and le^tlmate service-connected disability claims. Do yon have any 
research studies that await completion of GIS? Have the DoD and VA developed a 
protocol by which VA researchers can have access to the GIS? 

Response: VA i) ivestigators with Internal Review Board (IRB)-approved research 
projects have access to information currently available from the GIS. There is good 
cooperation betwijen VA and the GIS team. VA's Boston Environmental Hazards 
Research Center Jias already been granted access to GIS infoimation. VA does not have 
any research studies that await final completion of the GIS database. The value of the 
GIS A ?fi* is limited because it does not contain information on location of individual 
soldiers or locatidn information before January 1991. • 



86 



The Honorable Arka Specter 

Question 4: Tbe \ A has completed the first phase of the "National Health Survey of 
Persian GalfVetei ans and Their Families." The VA mailed oat a postal survey to 
15,000 Gulf War veterans and 15,000 Golf era veterans. I nnderstand that the 
response rate to th e initial mail survey was 56 percent What are your impressions 
as to '(vhy 44 percent of those contacted did not respond to the mail survey? Did the 
VA have current addresses causing the surveys to be "Returned to Sender^ Or is 
there a tendency for healthy veterans not to respond to the survey? I would believe 
a healthy veteran ^vould be less likely to respond to the survey than a sick one. 

Response: The pejcentage of veterans completing and returning the "National Health 
Survey of Persian (hllf Wax Veterans and Their Families" is typical of the expected 
response rate to mail surveys of this type. We agree that healthy individuals would be 
less likely to complete the Phase I questioimaire than people who are ill Also, non- 
Pexsian Gulf vetcraaa are probably less likely to respond to the survey than those who 
actually served in t lie Persian Gulf. 

The Phase II, a telephone foUow-up survey to non-respondents, is designed to 
correct for and assi;ss the degree of bias introduced by non-response. This phase of the 
National Survey is currently underway. 

VA utilized various databases, including VA and Internal Revenue Service (IRS) 
sources, to provide- the addresses used for the questionnaire mailing labels. In addition, 
the investigators engaged an outside contractor to locate the addresses of individuals 
whose surveys wei^e returned to \is stamped "Retumed to Sender." Despite these efforts 
approximately 5% of the questionnaiies were still returned by the U.S. Postal Service due 
to incorrect addrej^ses. Another outside contractor will conduct telephone interviews with 
the 8,000 veterans who did not respond to the mail questionnaire, as part of Phase n of 
this project. 

Thank you for the opportunity to provide additional information on these 
important issues. Please contact me if you should require any fiirther assistance. 

Sincerely yours, 




Kenneth W.-Kizer, M.D., M.P.H. 



87 



^ 



Department of 
Veterans Affairs 



ANNUAL REPORT TO CONGRESS 

Federally Sponsored Research on 
Persian Gulf Veterans' Illnesses for 1995 




The Research Working Group of the Persian Gulf Veterans Coordinating Board 



88 



Table of Contents 
INTRODUCTION 3 

RESEARCH MANAGEMENT - 3 

Overview OF Research Management 3 

Oversight OF Research 4 

Research Coordination 5 

EVENTS AND MILESTONES IN 1995 6 

Devtlopment of a Working Plan for Research of Persian Gulf Veterans' Illnesses 6 

DODA/A Solicitation OF New Research Projects 9 

Meeting OF Researchers AT Armed Forces Instttute OF Pathology 9 

Meeting OF THE American Public Health Association 10 

Milestones in Three Major Epidemiologic Research Efforts 10 

I'A National Health Survey of Persian Gulf Veterans JO 

The Health Assessment of Persian Gulf War Veterans from Iowa 10 

Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for Etiohgic Agents and Risk 
Factors 10 

STATUS OF COMPLETED AND ONGOING RESEARCH. 11 

Ontrview 11 

Noteworthy Research Results 14 

Comparative Mortality Among US Military Personnel Worldwide During Operations Desert Shield and 

Desert Storm - Department of Defense 14 

Mortality Follow-up Study of Persian Gulf Veterans - Department of Veterans Affairs 14 

Suspected Increase of Birth Defects and Health Problems Among Children Born to Persian Gulf 
Veterans in Mississippi - Centers for Disease Control and Prevention/State of Mississippi Department 

of Health 15 

Centers for Disease Control and Prevention (CDC) Investigation of Veterans in Pennsylvania - Centers 

for Disease Control and Prevention 15 

Epidemiological Studies of Morbidity Among Gulf War Veterans: A Search for Etiologic Agents and 

Risk Factors - Department of Defense, Naval Health Research Center 16 

Biomarkers of Susceptibility and Polycyclic Aromatic Hydrocarbon (PAH) Exposure in Urine and 
Blood Cell DNA from U.S. Army Soldiers exposed to Kuwait Oil Well Fires - National Institutes of 

Health " 17 

Acute Oral Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in the Laboratory Rat - 

Department of Defense 17 

Summary OF Current Findings 18 

EXPECTED MILESTONES IN 1996 ......19 

Research Accomplishments 19 

Other Milestones 19 

REFERENCES „ „ 20 



APPENDICES 

APPENDIX A - A Working Plan for Research on Persl^jm Gulf Veterans' Illnesses - Aug. 1995 

APPENDIX B - Persian Gulf Veterans' Illnesses Research Database 

APPENDIX C - Topical Bibliography Of Published Works Regarding The Health Of Veterans 

Of The Persl^ Gulf War Illnesses 

APPENDIX D - Abstracts from Annual American Public Health Association Meeting 

APPENDIX E - List of Research Papers and Reports 

APPENDIX F - Reprints of Relevant Peer Reviewed Research Papers 



89 



INTRODUCTION 

On August 31, 1993, in response to Public Law 102-585, President Clinton named 
the Department of Veterans Affairs (VA) as the lead agency for research into the health 
consequences of service in the Persian Gulf War. As part of its role as the lead research 
agency VA is required to submit to Congress an annual report on the results and progress 
of federally Junded Kseaich on Persian Gulf veterans' illnesses. This is the third of these 
annual reports. Because this document is a status report, and because it is restricted only 
to federally funded research, it does not attempt to interpret the aggregation of current 
research findings. 

In addition to the research efforts highlighted in this report, there have been several 
noteworthy research efforts in the private sector. Most recently, studies of infectious 
agents, pyridostigmine bromide, and other clinical issues have been reviewed by the 
Persian Gulf Veterans Coordinating Board. VA, DOD, and HHS senior clinical and 
research managers have met with interested non-federal investigators to be fially informed 
on (their) study outcomes. However, these private sector research efforts are not included 
in this report because this document is a status report on i\\t federally funded research on 
Persian Gulf Veterans Illnesses. 

This report is divided into four sections. The first section discusses the 
management of federal Persian Gulf veterans' illnesses research programs, including 
research oversight, peer-review and coordination. The following section highlights 
significant research events and milestones in the last year. The next section summarizes 
the status and results fi-om several important research projects and programs of the federal 
government (Appendix C contains a comprehensive listing of all research projects and 
programs conducted or sponsored by the federal government). The final section lists 
significant milestones anticipated for 1996. 

RESEARCH MANAGEMENT 
Overview of Research Management 

Research on Persian Gulf veterans' illnesses is complex, involving a number of 
different approaches and outcomes. The federal research enterprise involves scientists 
conducting research sponsored by VA, the Department of Defense (DOD), and the 
Department of Health and Human Services (HHS). Each of these Departments have 
distinct, though complementary, capabilities and capacities for conducting and sponsoring 
research on Persian Gulf veterans health issues. Each Department has its own 
appropriation for extramural and intramural general biomedical research programs The 
Department of Defense also has a separate item in its appropriation for DODA'^A 
collaborative research on health problems shared by veterans and active duty service 
members alike. 

The biomedical research programs in VA, DOD, and HHS have well established 
management structures for science policy formulation and the solicitation, scientific peer 
review, and fiinding of both extramural and intramural programs. The coordination and 
management of research on Persian Gulf veterans' illnesses has required the establishment 
of an overall research policy fi-amework linking each Department's research management 

3 



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hierarchy The link ge is provided through the Research Working Group of the Persian 
Gulf Veteran's Coordinating Board As an operation policy, the Research Working 
Group works through the line management authority each department maintains over its 
intramural scientists, scientific program managers (responsible for extramural research), 
and their budgets 

Oversight of Research 

Each Department engaged in research on Persian Gulf veterans' illnesses 
emphasizes the need for both prospective and retrospective peer review of research. 
Because of the urgency of the health concerns of Persian Gulf veterans and their families, 
as well as the diverse nature of the reported illnesses, review and oversight of research is 
essential. VA, DOD, and HHS have established multiple oversight mechanisms to capture 
the diverse nature of the overall effort, some oversight mechanisms are broad-based, 
encompassing all research issues, whereas others are more focused on individual research 
projects and programs 

Institute of Medicine/Medical FoUow-up Agency (under contract to VA and DOD): 
Healtit Consequences of Persian GulfSennce 

In 1993 VA and DOD jointly entered into a 3 year contract with the Medical 
Foliow-Up Agency (MFUA) of the Institute of Medicine (lOM), National Academy of 
Sciences CNAS) The lOM was charged with reviewing e?dsting scientific, medical and 
other information on the health consequences of military service in the Persian Gulf area 
during the Persian Gulf War The lOM was also to review the research activities and 
plans of the various involved agencies and make recommendations The lOM Committee 
on the Health Consequences of the Persian Gulf War released its interim report in January 
1995 (lOM. 1995) and will make its final report in September 1996 

In its Interim Report, the lOM made several recommendations to VA and DOD to 
improve their research programs on Persian Gulf veterans' illnesses In testimony 
delivered on March 1 1, 1996 to the Subcommittee on Human Resources and 
Intergovernmental Relations of the House Committee on Government Reform and 
Oversight, Dr John Bailar, Chairman of the lOM Committee on the Health Consequences' 
of the Persian Gulf War, stated that VA and DOD "...have largely acted in accord with our 
recommendations, and I am personally pleased with the progress that has been made to 
date "" 



Department of Veterans Affairs: Persian Gulf Expert Scientific Committee 

In late 1993 \'A chartered this standing federal advisory committee at the request 
of VA Secretary' Jesse Brown The purpose of the VA Expert Scientific Committee is to 
advise the VA Under Secretar>' for Health and the Assistant Chief Medical Director for 
Public Health and Environmental Hazards on medical findings affecting Persian Gulf 
veterans The Committee also reviews research activities The Committee consists of 18 



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members selected on the basis of high professional achievement, expenise in illnesses 
which might be related to Persian Gulf service, and research expertise in these areas The 
Committee has met seven times since early 1994 and has heard presentations from 
numerous scientists and clinicians. Tne deliberations of the Committee have provided a 
continuous review of VA clinical and research programs 

Executive Office of the President: Presidential Advisory Committee on Gulf War 
Veterans' Illnesses 

The President established this advisory committee by Executive Order on May 26, 
1995 The 12 member committee is composed of scientists, health care professionals, 
veterans, and policy experts The Committee is charged with reviewing and providing 
recommendations on the full range of government activities relating to Persian Gulf 
veterans' illnesses The full Committee has met five times and subcommittees reviewing 
clinical and research issues have met three times Each meeting has had public comment 
periods and invited presentations from clinicians, scientists, veterans, and government 
officials 

The Committee released an interim report in Februar\- 1996 Although the Interim 
Report stated that VA. DOD, and HHS research programs are generally well designed and 
should lead to answers, it also had several recommendations The Committee's 
recommendations covered issues such as peer review, coordination of agency research 
activities, the use of public advisory' committees and the availability of information on 
troop exposure The agencies have developed a coordinated plan of action (The Persian 
Gulf Veterans Coordinating Board, 1996) that responds to the Advisory Committee's 
interim recomendations The agencies will also respond to the recommendations 
contained in the final report, which is scheduled for release in December 1>96. 



Other Oversight 

In addition to the broad oversight provided by the three committees cited above, 
there are several standing and special committees responsible for oversight on individual 
research projects and programs Projects and programs receiving continuous or ad hoc 
oversight include: 

• The National Health Survey of Persian Gulf Veterans (VA) 

• Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for 
Etiologic Agents and Risk Factors (DOD) 

• Health Assessment of Persian Gulf War Veterans from Iowa (HHS) 

• Each of the three Environmental Hazards Research Centers (VA) 

Research Coordination 

In 1993, VA, DOD. and HHS recognized the importance of a coordinated 
approach to research on Persian Gulf veterans' illnesses In response to this need the 
three Departments formed the "Persian Gulf Interagency Research Coordinating Council" 



92 



By January 1994, when the Secretaries of V ;, DOD, and HHS formed the Persian Gulf 
Veterans Coordinating Board, the Council became the Research Working Group 
operating under the auspices of the Coordinating Board (Beach et al, 1995) Because of 
the potential link between environmental factors and Persian Gulf veterans' illnesses, the 
Environmental Protection Agency was asked to be a member of the Research Working 
Group 

The Research Working Group is charged with assessing the state and direction of 
research, identifying gaps in factual knowledge and conceptual understanding, identifying 
testable hypotheses, identifying potential research approaches, reviewing research 
concepts as they are developed, collecting and disseminating scientifically peer-reviewed 
research information, and insuring that appropriate peer review and oversight are applied 
to research conducted and sponsored by the federal government Membership on the 
Research Working Group consists of senior research and clinical managers from VA, 
DOD, HHS, and EPA To carry out this function, the Research Working Group meets at 
least monthly 



EVENTS AND MILESTONES IN 1995 

Development of A Working Plan for Research of Persian Gulf Veterans' 
Illnesses 

Assessments in 1994 of existing knowledge and data by the Defense Science 
Board Task Force (DSB). a National Institutes of Health Technology Assessment 
Workshop (NIH, 1994), and the National Academy of Sciences/Institute of 
Medicine/Medical Follow-up Agency (lOM) led the Research Working Group to the 
conclusion that significant investments in research would be required to ascertain the 
nature, extent, and causes of illnesses among veterans of the Persian Gulf War Although 
close coordination of research activities were taking place among investigators in VA, 
DOD, and HHS. it was determined that a written research plan encompassing the Federal 
research effort needed to be developed If constructed properiy, such a research plan 
would ensure that appropriate research questions are addressed, while at the same time 
avoiding unnecessary' duplication In 1995 a subcommittee of the Research Working 
Group was formed to draft A Working Plan for Research on Persian Gulf Veterans ' 
Illnesses The members of this subcommittee were senior research and clinical managers 
with expertise in clinical research, epidemiology, and toxicology The final research plan 
was approved by the full membership of the Research Working Group and concurred 
upon by top management of VA, DOD, and HHS in August 1995. 

As a starting point the subcommittee examined the valuable data assessments and 
research recommendations developed by the Defense Science Board Task Force (DSB, 
1994), the NTH Technology Assessment Workshop (NTH, 1994), and the Institute of 
Medicine (lOM. 1995) 

In defining the course of research three goals for research were established; 

1 Establishment of the nature and prevalence of symptoms, diagnosable 

illnesses and unexplained conditions among Persian Gulf veterans in 
comparison with appropriate control populations. 



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2. Identification of possible risk factors for any illnesses found among Persian 
Gulf veterans, 

3. Identification of appropriate diagnostic tools, treatment methods, and 
prevention strategies for illnesses found among Persian Gulf veterans. 

To the extent appropriate and feasible, these goals would also apply to veterans' 
family members 

The overall approach to development of the plan involved: identification of the 
knowledge required to reach the above goals, identification of the knowledge either 
currently available or obtainable fi^om ongoing research programs; and lastly identification 
of additional research areas necessary to close the gap between what is known and what is 
needed. In identifying the required knowledge, the subcommittee developed a set of 19 
research questions The first research question set the stage for all others: What is the 
prevalence of illnesses (wawfesied by signs and or symptoms) in the Persian Gulf 
veterans population'^ Hom' does this prevalence compare to that in an appropriate 
control group"^ 

Illnesses occur in any population over time, but it is currently not known whether 
Persian Gulf veterans are experiencing illnesses beyond those expected in such a 
population of relatively young, fit men and women The Persian Gulf registries of both 
VA and DOD cannot alone answer this question The registries are important tools for 
observing trends in reported symptoms and illnesses, and for developing research 
questions. As the research plan identifies, there are several ongoing and planned 
epidemiologic investigations that address this question Important among these are the 
VA National Health Survey, the VA Mortality Study, the epidemiologic studies of the 
Naval Health Research Center in San Diego, and the CDC studies of Iowa veterans and 
Pennsylvania Air National Guardsmen 

If these studies demonstrate in aggregate an increased prevalence of illnesses, then 
secondary questions regarding disease entity or entities must be addressed The plan 
identifies 18 secondary questions The questions are divided between exposure-related 
questions and health outcome-related questions. This was done to isolate two broad, 
interconnected questions: (1) what was the nature and extent of possible exposures 
experienced by veterans while in the Persian Gulf and (2) what specific adverse health 
outcomes have occurred among Persian Gulf veterans, beyond those normally expected in 
such a large adult population'' These two questions lead to a third question, namely: (3) is 
there a relationship, or set of relationships, between exposure to the complex environment 
of the Persian Gulf theater and any excess morbidity and mortality fi"om epidemiological 
data that is consistent with established biological and toxicological principles'' This last 
question needs to be addressed by investigating both exposures and health outcomes. 
Investigations of exposures can lead to hypotheses about expected health outcomes based 
on the nature and extent of the exposures, and investigations of health outcomes can lead 
to hypotheses about exposures. 

The exposure-related questions and the outcome-related questions were generated 
in large measure by a critical examination of the findings of the DSB (DSB, 1994), NIH 
(NIH, 1994), and lOM (lOM, 1995) panels This approach was important and was 



94 



endorsed by the Research Working Group It built on the very substa itial intellect lal and 
financial capital invested in these three distinguished panels. 

The subcommittee first categorized the exposure and outcomes areas of concern 
considered by the panels Exposure areas of concern identified by the three panels were: 

Infectious agents 

Smoke fi"om oil well fires/oil spills 

Other petroleum product exposures 

Other occupational exposures 

Potential chemical and biological warfare agents 

Vaccines 

Pyridostigmine bromide 

Psychological stressors of war 

Health outcomes of concern identified by the three panels were; 

Non-specific symptoms/symptom complexes 
Immune function abnormality 
Reproductive health outcomes 
Genitourinan,' disorders 
Pulmonary fijnction abnormalities 
Neuropsychological outcomes 
Leishmaniasis 
Neoplastic disease 
Mortality outcomes 

The subcommittee then assessed the importance placed on each arcu of concern by 
the three panels .Areas of clear consensus among the panels on exposures and outcomes 
were identified and issues for fijture research were then pnoritized based on scientific 
merit In areas of disagreement among the panels the subcommittee discussed the 
scientific merits of each view and made a decision as to its pnonty. Generally, the 
subcommittee included most exposure and outcome areas where the panels disagreed 
Not all areas were considered by all panels. In such cases an inclusive view also prevailed 

The mdividual research questions are enumerated in the Working Plan (Appendix 
A) Many of these research questions are being addressed by ongoing research and much 
of that research is focused appropriately along epidemiological lines The research plan 
delineates some specific areas of inquiry needing special emphasis: 

• Information on the prevalence of illnesses and diseases within other 
coalition forces, 

• Information on the prevalence of symptoms, illnesses and diseases 
within indigenous populations living in the Persian Gulf area, including 
Saudi Arabia and Kuwait, 

• Information on the prevalence of adverse reproductive outcomes 
among Persian Gulf veterans and their spouses, 

• Simple and sensitive tests for L. tropica infection that could lead to 
quantitation of the prevalence of I. tropica infection among Persian 
Gulf veterans, and 



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• Information on the long-term, cause-specific mortality among Persian 
Gulf veterans. 

The research plan was released publicly on August 4, 1995. It has received broad 
distribution, including publication on DOD's Gulflink home page on the World Wide Web 



DOD/VA Solicitation of New Research Projects 

The areas of specific inquiry identified at the end of the Working Plan were used 
by DOD in a solicitation for proposals contained in a Broad Agency Announcement in 
June 1995 Over 100 proposals were reviewed for scientific merit by external peer-review 
panels After ratings were assigned by the peer-review panels, summary review statements 
(redacted for investigator and institutional identifiers) were provided to a subcommittee of 
the Research Working Group (some subcommittee members were government officials 
fi"om outside of the Research Working Group) for the purpose of evaluating proposals for 
their relevancy to the research needs established by the Working Research Plan The 
subcommittee was not responsible for any ftirther scientific review, and relied on the 
scientific merit scores established by the independent, scientific peer-review panels The 
overall goal of the subcommittee was to identify the proposals that had the highest 
scientific merit and met the research needs established in the Working Research Plan The 
subcommittee developed its recommendations and provided them to the Research 
Working Group for endorsement The Research Working Group transmitted the 
recommendations to DOD through the Persian Gulf Veterans Coordinating Board The 
Department of Defense is currently finalizing negotiations with the offerors By the end of 
negotiations, it is anticipated that approximately 12 new research projects v. ill be funded 



Meeting of Researchers at Armed Forces Institute of Pathology 

The Research Working Group of the Persian Gulf Veterans Coordinating Board 
organized an informal meeting of federal government scientists and federally sponsored 
scientists engaged in research on Persian Gulf veterans' illnesses The meeting took place 
on June 14-15, 1995 at the Armed Forces Institute of Patholog>'. The purpose of the 
meeting was to provide scientists with a forum at which they could informally share 
problems, concerns, areas of commonality, and preliminary findings 

The first morning of this two day meeting was devoted to presentations on 
ongoing research related to the health of Persian Gulf veterans. Following the 
presentations, participants were broken into three working groups: epidemiology, 
toxicology, and clinical research The groups were charged with discussing the major 
issues with each of the working group areas. Groups were asked to document their 
discussions and present any recommendations to the whole assembly. 

The meeting was an important step in bringing researchers together to help ensure 
overall coordination of the federal research effort. 



96 



Meeting of the American Public Health Association 

A session of the Annual Meeting of the American Public Health Association 
(APHA) was devoted to epidemiologic research on Persian Gulf veterans' illnesses. The 
Meeting was held October 3 1 in San Diego, CA. Twelve papers on Persian Gulf veterans' 
illnesses were presented which included preliminary results of completed investigations 
and methodological approaches to planned and ongoing studies. Appendix D contains the 
abstracts of these presentations Some of the preliminary results presented at the APHA 
are described in the section on research status. 

IVIilestones in Three Major Epidemiologic Research Efforts 
VA National Health Survey of Persian Gulf Veterans 

The data collection phase of the VA National Health Survey of Persian Gulf 
Veterans began in 1995 The survey underwent extensive peer-review from a 
subcommittee of VA's Expert Scientific Panel, and was fijrther reviewed by the Office of 
Management and Budget Details of the survey are provided below 

Sur\'ey questionnaires were sent to 30,000 Persian Gulf veterans in November 
1995. A second follow-up mailing was sent out in January 1996. This phase of the 
National Health Survey should be complete by May 1996 VA plans to conduct two more 
phases of the study, a telephone interview and physical examinations, and hopes to 
complete the National Health Sur^■ey by Spring 1998 

The Health Assessment of Persian Gulf War Veterans from Iowa 

Data collection has begun on a telephone survey of self-reported health 
assessments in a stratified random sample of approximately 3000 Iowa veterans divided 
into four study groups active duty service members deployed to the Persian Gulf, 
National Guard and reserve service members deployed to the Persian Gulf, non-deployed 
active duty service members of the Persian Gulf era; and non-deployed National Guard 
and reserve service members of the Persian Gulf era Results from this study are expected 
by Summer 1996 This program is being conducted by the Iowa Department of Public 
health in conjunction the University of Iowa through a cooperative agreement with the 
CDC 



Epidemiologic Studies of Morbidity' Among Gulf War Veterans: A Search for 
Etiologic Agents and Risk Factors 

This large program is being conducted by the Naval Health Research Center. 
Overall, seven epidemiologic studies are underway. Study 1 is a cross sectional study of 
1,500 Seabees (Navy construction workers) that compares post-war morbidity among 
those who were deployed to a non-deployed control group Study 2 is a comparative 
study of DOD hospitalization records for deployed and non-deployed active duty 
personnel from the Persian Gulf era. About 1 .2 million service members are involved in 
this re\iew of hospitalization records which compares the hospitalization experience 

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between deployed and non-deployed active duty personnel from the Persian Gulf era. 
Study 3 utilizes the same data base as study 2 to compare birth outcomes in spouses of 
active duty service members deployed to the Persian Gulf with non-deployed service 
members. Study 4 is a survey of married couples in which at least one spouse was 
deployed during the Persian Gulf War. The survey is intended to ascertain pregnancy 
outcomes (premature birth and spontaneous abortions) and reproductive success 
(infertility) Approximately 21,000 couples wnll be surveyed. Study 5 is a large-scale 
survey of all 17,000 Seabees who were on active duty during the Persian Gulf War, 
including those who have left military service. The objective is to identify any latent health 
effects among Persian Gulf veterans Study 6 is a study of hospitalization records in non- 
federal hospitals in California as a measure of health in those who have left military 
service Study 7 is an examination of several state birth defects registries to compare the 
rate of birth defects in offspring of deployed Persian Gulf veterans (spouses) with that in 
offspring of non-deployed Persian Gulf veterans 

STATUS OF COMPLETED AND ONGOING RESEARCH 

Overview 

Appendix B comprises the current contents of the Persian Gulf Veterans' Research 
Database This database was last updated during the first quarter of FY'96 Research 
projects are grouped according to the Depanment that is responsible for the conduct or 
sponsorship of the research 

Each entry in the database includes 

Project Title 

Responsible Federal Agency 

Study Location 

Project Start-up Date 

Project Completion Date (estimated if ongoing) 

Overall Objectives of Project 

Specific Aims of Project 

Methods of Approach 

Expected Products (Milestones) 

Current Status Results 

Publications 

Virtually all current federal research directly related to Persian Gulf veterans' 
illnesses is sponsored by VA, DOD, or HHS. These three Departments currently sponsor 
69 distinct research projects on Persian Gulf veterans' illnesses, of which 51 are ongoing, 
and 18 are complete . This does not count the approximately 12 new research programs 
to be fijnded by DOD as a result of a Broad Agency Announcement issued last year. Nor 
does it count research proposals currently before VA's Medical Research Service Merit 
Review Committee VA alone is conducting or sponsoring 35 projects, of which 27 are 



A project is considered complete when all data have been collected and ana]>zed There will be a delay 

bet\\een completion and publication of results to allow for adequate scientific peer-re\iew. 

11 



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ongoing and 8 are complete Most of the large research projects and programs, such as 
the large epidemiology studies and VA's three Environmental Hazards Research Centers 
(encompassing 14 projects alone), involve some participation of VA, DOD, HHS, and 
EPA 

The scope of the federal research portfolio is very broad In size, projerts range 
from small pilot studies utilizing limited or no direct appropriated research funds, up to 
large-scale epidemiology studies and major research center programs utilizing significant 
amounts of appropriated research funds 

The areas of current research focus are categorized as follows: 

PREVALENCE AND RISK FACTORS FOR SYMPTOMS AND 
ALTERATIONS IN GENERAL HEALTH STATUS 

BRAIN AND NERVOUS SYSTEM FUNCTION 

EWTRONMENTAL TOXICOLOGY 

REPRODUCTH E HEALTH 

DEPLETED URANIUM 

LEISHMANIASIS 

IMMUNE FUNCTION 

PYRIDOSTIGMINE BROMIDE 

MORTALITY EXPERIENCE 

MISCELLANEOUS 

Within each of these focus areas there may be several different approaches 
Approaches range in type from basic research, addressing potential biological mechanisms 
of causation, to clinical and epidemiological research that attempts to ascertain illness 
prevalence and risk factors Although precise categorization of research types can be 
difficult because of overlapping methodologies, Persian Gulf veterans' illnesses research 
projects can be divided into the following general types 

BASIC RESEARCH: encompasses research into mechanisms of disease using /// 
vitro and ni vivo models in humans and laboratory animals 

CLINICAL RESEARCH: application of an intervention, such as in a controlled 
drug trial 

CLINICAL EPIDEMIOLOGY: uses epidemiological techniques focused on 
specific disease or syndrome outcomes Most case-control studies fall under this 
cateeorw 



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EPIDEMIOLOGY RESEARCH: includes population-based studies focused on 
outcomes such as mortality, symptoms, hospitalizations, etc., using devices such as postal 
surveys, telephone interviews, and records reviews 

APPLIED RESEARCH: application of known scientific principles to a specific 
objective such as vaccine or drug development. 

Appendix B classifies all research projects by focus area and within each focus area 
by the type of approach At the end of Appendix B Gant charts are provided graphically 
depicting the projected timelines on cataloged research projects. It should be emphasized 
that these timelines represent current projections and are subject to change. 

The Persian Gulf Veterans' Illnesses Research Database catalogs only research 
which is deemed to be directly related to the health problems of Persian Gulf veterans 
The database takes no account of the vast accumulated knowledge derived fi^om the 
nation's investment in the biomedical research enterprise of the last 40 years. 

Lastly, the Persian Gulf Veterans' Research Database only contains research that is 
federally sponsored This includes research conducted by federal scientists, as well as that 
by non-federal scientists supported by federal research ftinds through grants and contracts 
It is not possible to ensure that all research efforts are tracked that fall within the private 
sector or otherwise outside of the purview of the federal government Notwithstanding, 
the Research Working Group attempts to stay abreast of all research relevant to Persian 
Gulf veterans" illnesses The Research Working Group accomplishes this by monitoring 
the peer rexiewed published scientific literature, attending scientific meetings, and even 
using newspaper repons and word-of-mouth The Research Working Group has used 
these methods to identifS researchers, for example, from M D Anderson Cancer Center in 
Houston, Texas. Duke University m Durham, North Carolina; and the University of Texas 
Southwest Medical Center in Dallas, Texas who are conducting non-fedeially sponsoreo 
research related to Persian Gulf veterans' Illnesses Investigators fi"om these institutions 
were invited and presented their research to the Research Working Group in Washington, 
DC during 1995 

Regardless of the entity that supports particular research projects, all research that 
has undergone rigorous peer review and has been published in peer reviewed scientific 
literature will ultimately be used in formal assessments of nature and cause(s) of Persian 
Gulf veterans' illnesses 



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Noteworthy Research Results 

In the prior year there have been several research projects which have begun to 
produce results that provide a preliminary, albeit tentative, view of the health problems of 
Persian Gulf veterans This section provides brief descriptions of these research projects 
and their results Publications resulting from these projects are bsted in Appendix E and 
copies of key peer reviewed papers are in Appendix F Some preliminary results of 
several research projects were presented at the Annual Meeting of the American Public 
Health Association (APHA) held in San Diego, CA, in October 1995. 

It must be stressed that results from each one of these projects alone cannot be 
used to draw generalizable conclusions regarding the health of Persian Gulf veterans and 
their family members Each study has addressed, or is currently addressing, focused 
research questions which in some cases were directed at specific subpopulations of Persian 
Gulf veterans As additional research studies are completed and their results enter the 
scientific literature, a more complete synthesis of results will be feasible. 



Comparative Mortality Among US Military Personnel Worldwide During 
Operations Desert Shield and Desert Storm - Department of Defense 

This study examined the disease and non-battle injury (DNBI) mortality experience 
of all US militaP)' personnel during a 1 year period which included the Persian Gulf War. 
The DNBI death rates among militar\' personnel deployed to the Persian Gulf were not 
increased when compared to non-deployed personnel There was also no evidence of 
clusters of unexpected deaths (Writer. 1996) 



Mortality Follow-up Study of Persian Gulf Veterans - Department of Veterans 
Affairs 

The cause-specific mortality experience of 695,292 service members deployed to 
the Persian Gulf during Operations Desert Shield/Desert Storm between August 1990 and 
April 1991 was compared to 746,038 non-deployed U.S. service members (Kang et al, 
1995). Follow-up on these veterans began on May 1, 1991, or the date they left the 
Persian Gulf area alive, and ended on September 31, 1993 During the defined period 
there were a total of 1,765 deaths from all causes among deployed veterans while the 
number expected in a comparable U.S civilian population was 4,01 1 . The observed 
deaths due to all causes among deployed Persian Gulf veterans was, however, greater 
than that in a comparable non-deployed military population during that same period. 
These excess deaths among deployed veterans are primarily attributed to external causes 
including all accidents and motor vehicle accidents No excess deaths were observed for 
suicide and homicide among the Gulf veterans. When deaths due to accidents, suicide, and 
homicide (external causes) were excluded (leaving only disease-related causes of death), 
the number of deaths among deployed veterans was 543 while the number expected was 
624 based on the mortality rate among the non-deployed veterans. The computed 
disease-related death rates using these data are not different between deployed and non: 

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deployed veterans Despite the difference in overall mortality between deployed and non- 
deployed veterans, the mortality risk from all causes for deployed veterans was still less 
than half of what was expected from a comparable US population during the same 
period The Department of Veterans Affairs plans to conduct further mortality follow-up 
studies at appropriate time intervals. 



Suspected Increase of Birth Defects and Health Problems Among Children Born to 
Persian Gulf Veterans in Mississippi - Centers for Disease Control and 
Prevention/State of Mississippi Department of Health 

In late 1993 there was a report of an apparent cluster of birth defects and other 
health problems among children bom to veterans of two Mississippi National Guard units 
that had been deployed to the Persian Gulf during Operations Desert Shield/Desert Storm 
The Department of Veterans Affairs in Jackson, Mississippi, the Mississippi State 
Department of Health, and the Centers for Disease Control and Prevention conducted a 
collaborative investigation to determine whether an excess number of birth defects 
occurred among children bom to this group of veterans Investigators reviewed the 
medical records of all children conceived by and bom to veterans of these two units after 
deployment to the Persian Gulf The total number of major and minor birth defects was 
not greater than expected Limitations of statistical power due to the small number of 
births (54) prevented the drawing of conclusions about the occurrence of specific birth 
defects. The frequenc>' of premature birth and low birth weight also appeared similar to 
that in the general population (Penman et al, 1996). 



Centers for Disease Control and Prevention (CDC) Investigation of Veterans in 
Pennsylvania - Centers for Disease Control and Prevention 

In November 1994 the Department of Veterans Affairs, Department of Defense, 
and the Pennsylvania Department of Health requested that the CDC investigate a report of 
illnesses among members of an Air National Guard Unit The CDC conducted a three 
stage investigation to: 1) characterize signs and symptoms among in the veterans of this 
unit who were being seen at a local VA medical center, 2) determine whether the 
prevalence of symptoms was higher among members of this unit compared to other 
deployed and non-deployed units, and 3) characterize illnesses and identify risk factors. 
At this time, stages 1 and 2 have been completed 

In the first stage 59 symptomatic Persian Gulf veterans from the VA Medical 
Center in Lebanon, PA, were interviewed and received standard physical exams Twenty 
six of the veterans were selected from the VA Persian Gulf Registry, 14 were typical cases 
identified by the reporting VA physician, and 1 9 were listed on the VA Persian Gulf 
Registry but had not been evaluated by the VA medical center. Of the 59 veterans, 30 had 
been assigned to the index unit. A variety of symptoms were reported, including: fatigue, 
joint pain, nasal or sinus congestion, diarrhea, joint stiffness, unrefreshing sleep, excessive 
gas, difficulty remembering, muscle pains, headaches, abdominal pains, general weakness, 
and impaired concentration 



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] I the second stage, members of the index unit and three compa ison units were 
surveyed to determine the prevalence of selected symptoms identified in stage 1 The 
three comparison units included deployed and non-deployed veterans In all units chronic 
symptom prevalence was significantly greater among deployed than non-deployed 
veterans The prevalences of symptoms from five categories: chronic diarrhea, 
gastrointestinal complaints, difficult remembering or concentrating, "trouble finding 
words", and fatigue, were all reported more often in the deployed Persian Gulf veterans 
from the index unit than the deployed veterans from the other units. 

Third stage data collection is complete and analysis of the data is underway. (CDC, 
1995) 



Epidemiological Studies of Morbidity Among Gulf War Veterans: A Search for 
Etiologic Agents and Risk Factors - Department of Defense, Naval Health Research 
Center 

The Naval Health Research Center has undertaken seven epidemiological 
investigations of Persian Gulf veterans and their family members Descriptions of each of 
these studies can be found in the Appendix B Three studies have produced preliminary 
results which were reported at the Annua! Meeting of the American Public Health 
Association Meeting in San Diego. CA in October 1995. A brief summary of these studies 
and their preliminar\' findings are given below The remaining four studies are in various 
stages of progress as reported in the Appendix B 

Study 1: A Study of Symptoms among 1500 Seabees 

This is a cross-sectional study of morbidity (risk factors and symptoms) of 
Seabees (Navy construction workers) who had been on active duty since September 1990 
Seabees studied (n=1498) included service members who were deployed to the Persian 
Gulf during Operations Desert Shield/Desert Storm, and those who were non-deployed. 
All volunteers completed a symptom questionnaire, provided blood and urine specimens, 
had height and weight measured, and performed a hand-grip strength test A subset of 
volunteers had measurements of pulmonary function made by spirometric techniques. 
Preliminary data show that deployed Persian Gulf veterans reported a higher prevalence of 
symptoms such as fatigue, headache, muscle or joint pain, and report a higher level of 
various exposures When compared to the non-deployed group, the deployed veterans 
also had higher scores on several abnormal psychological variables. There were no 
observed differences between the two groups in measurements of hand-grip strength and 
pulmonan.' fijnction 



Study 2: A Comparative Study of Hospitalizations Among Active-Duty Personnel who 
Participated in the Gulf War and Similar Personnel who did not 

This was a retrospective cohort study in which hospital discharge records from all 
DOD hospitals were examined for two groups of service members The first group 

16 



103 



consisted of nearly all active-duty personnel who deployed to the Persian Gulf between 
August 1, 1990 and July 31, 1991 (N=578,492). The second group consisted of a 50% 
random sample of personnel (N=699,792) who were on active duty as of September 30, 
1990 and were not deployed to the Persian Gulf before July 1991. The hospitalization 
rate of deployed service members was lower when compared with non-deployed service 
members for the period before the Persian Gulf War. That rate has slowly risen since the 
Persian Gulf War approaching the hospitalization rate of the non-deployed veterans. This 
time-dependent phenomenon probably reflects a "healthy soldier" effect. 



Study 3: A Comparative Study of Pregnancy Outcomes Among Gulf War Veterans 
and Other Active-Duty Personnel 

The cohorts described in Study 2 were used in this study. Pregnancy outcomes in 
the spouses of veterans in these cohorts, and in female Persian Gulf veterans in these 
cohorts were examined based upon DOD hospital records. Pregnancy-related outcomes 
including spontaneous abortions, stillbirths, and live births were available Pediatric 
conditions of livebom children, including birth defects recognized after delivery were also 
available. Pregnancy outcomes among spouses of service members were considered 
separately from female service members Preliminary results presented at the American 
Public Health Association Meeting indicated no overall difference in pregnancy outcomes 
or birth defects between the deployed and non-deployed cohorts. Final results are pending 
fijrther data analysis which is ongoing 



Biomarkers of Susceptibility and Polycyclic Aromatic Hydrocarbon (PAH) 
Exposure in L'rine and Blood Cell DNA from U.S. Army Soldiers exposed to Kuwait 
Oil Well Fires - National Institutes of Health 

In this study urinary metabolites of PAH, PAH-DNA adducts, and genetic 
polymorphisms were measured in 62 soldiers in June 1991 prior to deployment to Kuwait, 
eight weeks into their deployment, and after their return to Germany from Kuwait in 
October 1991 PAH-DNA adduct levels were actually higher in Germany compared to 
Kuwait These results are consistent with measurements of surprisingly low ambient PAH 
levels in Kuwait in the areas where these soldiers were working despite the presence of oil 
well fires nine miles to the north They suggest that these soldiers may not have 
experienced significant exposures to PAHs associated with the incomplete combustion of 
petroleum while stationed in Kuwait. 



Acute Oral Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in 
the Laboratory Rat - Department of Defense 

Pyridostigmine bromide (PB) is a cholinesterase inhibitor (ACHE) that was 

supplied to troops for use as prophylaxis against exposure to nerve agents. PB was 

distributed to troops in blister packs of 21 tablets of 30 mg each PB tablets were taken 

on order when it was believed a gas attack was imminent The recommended dosage was 
__ _ 



104 



one tablet every 8 hours PB has t een in use for decades (at much higher dosages) in the 
treatment of patients with myasthenia gravis. Short-term side effects are well known ~ 
eg , nausea, vomiting, diarrhea, abdominal cramps, increased salivation, miosis, headache 
and dizziness There have been no documented long-term side effects in humans of this 
drug 

The simultaneous or sequential administration of neurotropic compounds (for 
example, PB and the insect repellent DEET) conceivably could interact to produce an 
additive or synergistic effect However, previous research has indicated that PB does not 
persist in the body (Breyer-Pfaff et al, 1985) and, therefore, is unlikely to cause any long- 
term effects 

In 1995 DOD investigators completed a study of the acute interactions of PB, 
DEET, and permethrin when administered orally to rats (US Army, 1995, see also 
Appendix B) The endpoint studied was lethality at extremely high doses. They found 
synergism of effect when PB was combined with DEET and permethrin (another insect 
repellent) The relevance of high dose acute oral toxicity studies to the potential for 
chronic effects from acute low-level exposures is unknown The lOM panel (lOM, 1995) 
concluded that PB is a well-studied medication belonging to a class of drugs about which 
ex-tensive knowledge exists and that PB could interact with other compounds to cause 
acute and shon-term problems, but was unlikely to cause chronic effects. Nonetheless, 
the lOM panel recommended that the possibility of chronic neurotoxic effects needs to be 
tested in appropriate animal models (lOM, 1995) 



Summary of Current Findings 

Findings from some of the early studies just being reported indicate the following: 

• Some cohorts of Persian Gulf veterans report an excess of symptoms in 
comparison with non-deployed veterans of the same era A connection 
between symptoms and a specific disease pathoIog\' or pathologies has not 
been identified Until more epidemiological studies are complete, it is not 
possible to generalize these resuhs to the entire Persian Gulf veteran 
population 

• Based on VA and DOD mortality studies to date, there does not appear to be 
an excess of disease-specific deaths in Persian Gulf veterans when compared to 
veterans of the same era 

• The Navy study of hospitalizations indicates that, at least among active duty 
personnel, the rate of hospitalizations of Persian Gulf veterans does not exceed 
their non-deployed counterparts This suggests that Persian Gulf veterans are 
not experiencing an excess of illnesses of a severity that would lead to 
hospitalization Caution must be exercised, however, in drawing a more 
general conclusion because the study does not account for veterans who may 
have left the military, or Reserve/National Guard personnel. 

• One focused study of a small cohort of Persian Gulf veterans and one study of 
militarv' hospitalizations did not uncover an overall excess of birth defects 
among their offspring Although reassuring, caution must be exercised in 
drawing more general conclusions about birth outcomes. Several ongoing 



105 



epidemiologic studies are investigating pregnancy and birth outcomes. Results 
from these studies will begin to be available in 1996. 

• A DOD study of the interaction of PB, DEET, and permethrin in high dose, 
orally-exposed rats provides evidence in an animal model for synergistic effects 
of these compounds. This research suggests the need for further exploration of 
the potential interactive effects of these compounds at doses of greater 
relevance to humans Research currently being conducted by DOD and VA will 
attempt to further address issues of PB and other compounds that could have 
interacted Aviih it. 

Once results from ongoing research becomes available we should have better 
knowledge of 

• the relationship between symptoms and clinical illness(es); 

• risk factors for various illnesses; 

• the risk of adverse reproductive outcomes 



EXPECTED MILESTONES IN 1996 
Research Accomplishments 

• Completion of the Health Assessment of Persian Gulf War Veterans 
from Iowa 

• Completion of Phase I of the National Health Survey of Persian Gulf 
Veterans 

• Completion of Pennsylvania Air National Guard Study 

• Completion of 14 other research projects 

Other Milestones 

• Publication of final report of the lOM panel on Health Consequences 
ofSenice in the Persian Gulf 

• Publication of final report of the Presidential Advisory Committee on 
Gulf War Veterans ' Illnesses 

• A Working Plan for Research on Persian Gulf Veterans ' Illnesses - 
Revised 



19 



40-180 97 - 5 



106 



REFERENCES 

Beach P, Blanck RR, Gerrity T. Hyams KC, Mather S, Mazzuchi JF, Murphy F, Roswell 
R, Sphar RL Coordinating federal efforts on Persian Gulf War veterans Fed Prac 12:9- 

16, 1995 

Breyer-Pfaff U, Maier U, Brinkman ANM, Schumm F Pyridostigmine kinetics in healthy 
subjects and patients with myasthenia gravis Clin Pharmacol Ther. 37:495-501, 1985. 

Centers for Disease Control (CDC) Morbidity and Monality Weekly Report: Unexplained 
Illness Among Persian Gulf War Veterans in an Air National Guard Unit: Preliminary 
Report Aug 1990 - Mar 1995 44(23):443-447, 1995. 

Defense Science Board (DSB) Final Report Defense Science Board Task Force on 
Persian Gulf War Health Effects Washington, DC: Office of the Under Secretary of 
Defense Acquisition and Technology 

Institute of Medicine (lOM) Health Consequences of Service During the Persian Gulf 
War Initial Findings and Recommendations for Immediate Action. Committee to Review 
the Health Consequences of Service During the Persian Gulf War Medical Follow-Up 
Agency, Institue of Medicine National .Academy Press, Washington, DC. 1995. 

Kang HK, Bullman T.A. Monality Follow-up Study of Persian Gulf Veterans. Presented at 
the Annual Meeting of the American Public Health Association Meeting, October 31, 
1995 (See Appendix D) 

National Institutes of Health (NIH) Technology Assessment Workshop Panel: The Persian 
Gulf experience and health JAMA 272(5)391-396, 1994 

Penman A, Tarver R, Currier M No evidence of increase in birth defects and health 
problems among children bom to Persian Gulf war Veterans in Mississippi Military 
Medicine 161 1-6 1996 

The Persian Gulf Veterans Coordinating Board Action Plan April 25, 1996. 

US Army Center for Health Promotion and Preventive Medicine Report. Acute Oral 
Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in the Laboratory Rat 
Toxicoiogical Study 75-48-2665, May 31, 1995 

Writer J\', DeFraites RF, Brundage JF Comparative mortality among US military 
Personnel in the Persian Gulf region and worldwide during Operations Desert Shield and 
Desert Storm JAMA 275:1 18-121, 1996 



20 



107 
VA PROGRAMS FOR PERSIAN GULF VETERANS 

Januar> 1996 



The Department of Veterans Affairs fVA) offers Persian Gulf veterans special examinations and priority follow-on 
care, and it operates a toll-free hotline at 800-749-8387 to inform these veterans of the program and their benefits. 
VA also IS compensating veterans under unprecedented regulations addressing undiagnosed conditions. Special 
research centers and additional medical investigations are searching for answers to aid seriously ill patients whose 
underlying disease is unexplained. Most Gulf veterans are diagnosed and treated; but for some, such symptoms as 
joint pain or fatigue have been chronic. Some have responded to treatment of symptoms even though their doctors 
have not yet identified an imderlying illness or pathogenic agent. 

UNEXPLAINED ILLNESS: 

The prevalence of unexplained illnesses among Persian Gulf veterans is uncertain. Data from special VA 
examinations show that 8,980 veterans had current symptoms and did not receive a diagnosis. This may be an 
overestimate or underestimate of the problem of "undiagnosed illnesses" as the diagnoses recorded may not explain 
all the symptoms. Further, VA does not have information on the chronology, severity or current existence of the 
symptoms. Answers about illness prevalence are expected through research involving representative samples of the 
Gulf veteran population (see page 3). 

PERSL\N GULF "SYNDROME" UNDEFINED: 

Several panels of government physicians and private-sector scientific experts have been unable to discern any new 
illness or unique symptom complex such as that popularly called "Persian Gulf Syndrome." "No single disease or 
syndrome is apparent, but rather multiple illnesses with overlapping symptoms and causes," wrote an outside panel 
led by professors from Harvard and Johns Hopkins University that convened for an April 1994 National Institutes 
of Health (NIH) workshop. VA has neither confirmed nor ruled out the possibilirv' of a singular Gulf syndrome. 

RESEARCH AND RISK FACTORS: 

With variation in exposures and veterans' concerns ranging from depleted uranium in armaments to possible 
contamination from Iraqi chemical/biological agents. VA has initiated wide-ranging research projects evaluating 
illnesses as well as risk factors in the Gulf environment, spending $2.75 million in fiscal year 1995. The activation 
of three research centers conducting 14 protocols has enabled VA to broaden its activity from largely descriptive 
evaluations to greater emphasis on hypothesis-driven research. 

Statistics 

Some 945,000 servicemembers served in the Gulf from August 1990 through the end of 1994, nearly 697,000 of 
them serving in the first year, .^bout 505,600 have become potentially eligible for VA care as veterans, having 
either left the militarv- or having become deactivated reservists or Guard members. More than 54,000 veterans have 
responded to VA's outreach encouraging any Gulf veteran to gel a free physical exam under V.'^'s Persian Gulf 
Program. Not all are ill: 

13 percent of the veterans who had the registry health exam had no health complaint (among the first 44.190 
computerized records). 



108 



25.5 percent ot ihc same group rated their health as poor or ver> poor, while 73 percent reported their health as all 
right to ver\ good (the remaining 1.5 percent did not have an opinion). 

SPECIAL HEALTH EXAMINATION: 

A free, complete physical examination with basic lab studies is offered to ever\ Persian Gulf veteran, whether or 
not the veteran is ill. A centralized registr> of participants, begun in August 1992. is maintained to enable VA to 
update veterans on research findings or new compensation policies through periodic newsletters. This clinical 
database also provides information about possible health trends and may suggest areas to be explored in future 
scientific research. The 54.000 Persian Gulf veterans who have taken advantage of the physical examination 
program become part of a larger Persian Gulf Registry. As defined by P. L. 102-585. this includes 181.000 Gulf 
veterans (generallv including those counted in the special examination program) who have been seen for routine 
VA hospital or clinic care, or who have filed compensation claims -- or whose survivor registers a claim. 

PERSIAN GULF INFORMATION CENTER: 

VA offers a toll-free information line at 800-PGW-VETS (800-749-8387) where operators are trained to help 
veterans with general questions about medical care and other benefits. It also provides recorded messages that 
enable callers to obtain information 24 hours a day. Information also is being disseminated 24 hours a day through a 
national computer bulletin board, VA-ONLINE, at 800-USl-VETS (800-871-8387). It also can be reached at 
telnet://vaonline.va.gov via the Internet. 

PRIORITY ACCESS TO FOLLOW-ON CARE: 

VA has designated a physician at every VA medical center to coordinate the special examination program and to 
receive updated educational materials and information as experience is gained nationally. Where an illness possibly 
related to exposure to an environmental hazard or toxic substance is detected during the examination, followup care 
is provided on a priority basis. As with the health examination registry. VA requested and received special statutory 
authority to bypass eligibility rules governing access to the VA health system. 

PERSIAN GULF REFERRAL CENTERS: 

If the veteran's illness defies diagnosis, the veteran may be referred to one of four Persian Gulf Referral Centers. 
Created in 1992. the first centers were located at VA medical centers in Washington, DC; Houston: and Los 
.\ngeles, with an additional center designated at Birmingham. Ala., in June 1995. These centers provide assessment 
by specialists in such areas as pulmonary and infectious disease, immunology, neuropsychology, and additional 
expertise as indicated in such areas as toxicology or multiple chemical sensitivity. There have been approximately 
287 veterans assessed at the centers; most ultimately are being diagnosed with known/definable conditions. 

STANDARDIZED EXAM PROTOCOLS: 

VA has expanded its special examination protocol as more experience has been gained about the health of Gulf 
veterans. The protocol elicits information about symptoms and exposures, calls the clinician's attention to diseases 
endemic to the Gulf region, and directs baseline laboratory studies including chest X-ray (if one has not been done 
recently), blood count, urinalysis, and a set of blood chemistry and enzyme analyses that detect the "biochemical 
fingerprints" of certain diseases. In addition to this core laboratory work for every veteran undergoing the Persian 
Gulf program exam, physicians order additional tests and specialty consults as they would normally in following a 
diagnostic trail — as symptoms dictate. If a diagnosis is not apparent, facilities follow the "comprehensive clinical 
evaluation protocol" originally developed for VA's referral centers and now used in VA and military medical 
centers nationwide. The protocol suggests 22 additional baseline tests and additional specialty consultations. 



109 



outlining dozens of further diagnostic procedures to be considered, depending on symptoms. 

Veterans have reported a wide range of factors observed in the Gulf environment or speculative risks about which 
they have voiced concerns. Some are the subject of research investigations and none have been ruled out. There 
appears to be no unifying exposure that would account for all unexplained illnesses. Individual veterans' exposures 
and experiences range from ships to desert encampments, and differences in military occupational specialty 
frequently dictate the kinds of elements to which servicemembers are exposed. 

Veteran concerns include exposure to the rubble and dust from exploded shells made from depleted uranium (or 
handling of the shells); the possibility of a yet-unconfirmed Iraqi chemical-biological agent; and a nerve agent 
pre-treatment drug, pyridostigmine bromide. Many other risk factors also have been raised. In 1991 , VA initially 
began to develop tracking mechanisms that matured into the Persian Gulf Registry as a direct consequence of early 
concerns about the environmental influence of oil well fires and their smoke and particulate. InteragencN' 
Coordination and White House Response 

The federal response to the health consequences of Persian Gulf service is being led by the Persian Gulf Veterans 
Coordinating Board composed of the Departments of VA, Defense and Health and Human Services. Working 
groups are collaborating in the areas of research, clinical issues and disability compensation. The Board and its 
subgroups are a valuable vehicle for communication between top managers and scientists, including a staff office 
for the Board that follows up on critical issues and promotes continuity in agency activities. President Clinton 
designated VA as the Coordinating Board's lead agency. 

In March 1995, President Clinton announced formation of a Presidential Advisory Committee on Gulf War 
veterans' illnesses to review and make recommendations on: Coordinating Board activities; research, medical 
examination and treatment programs; federal outreach; and other issues ranging from risk factors to chemical 
exposure reports. It has been meeting since August 1995 and currently is developing an interim report. Medical 
Research 

Environmental Hazards Research Centers: 

Through a vigorous scientific competition, VA developed major focal points for Gulf veteran health studies at three 
medical centers: Boston; East Orange, N.J.; and Portland. Ore. With 14 protocols among them, the centers are 
conducting a variety of interdisciplinary projects, including some aimed at developing a case definition for an 
unexplained illness and clarification of risk factors. Some protocols involve areas of emerging scientific 
understanding, such as chronic fatigue syndrome or multiple chemical sensitivity, while others are evaluating or 
comparing factors in immunity, psychiatry, pulmonary response, neuroendocrinology and other body systems, some 
at the molecular level. 

Health Survey and Mortality Study. 

VA's Environmental Epidemiology Service is surveying 15,000 randomly selected Gulf veterans and an equal size 
control group of veterans of the same time period (but who were not deployed) to compare symptoms in veterans 
and their family members, examining risk factors and providing physical examinations for a representative sample 
to help validate the self-reported health data. That office also is engaged in a mortality study, analyzing death 
certificates to determine any patterns of difference in causes of deaths between deceased Gulf veterans and matched 
controls. Preliminary data have suggested the deployed veterans have a higher rate of post-war deaths due to 
accidents and traumatic injury as opposed to diseases or illness. Further analysis is continuing, with a report 
expected to be submitted for publication in a scientific journal later this year. (Independent of the study, VA has 
learned of 2,900 deaths among deployed veterans, which is lower than expected under general U.S. mortality rates.) 

Exposure-Oriented Studies: 



110 



Some current VA investigations are examining hypotheses of specific potential rislcs and comparing study subjects 
with controls who did not ser\'c in the Gulf to determine differences in heahh patterns. A Uaitimore project is 
following the health status of individuals who retained tiny embedded fragments of depleted uranium. 

A Birmingham, Ala., pilot program ofTers an extensive battery of neurological tests aimed at detecting dysfunction 
that would be expected after exposure to certain chemical weapons. 

Other Federal and Collaborative Studies: 

In its second annual report to Congress in March 1995, VA, on behalf of the Persian (iulf Veterans Coordinating 
Board participating agencies, detailed about 50 Persian Gulf research initiatives, reviews and clinical investigations, 
many involving VA. For example, VA investigators are collaborating with the Naval Medical Research Center in 
San Diego in general epidemiological studies comparing Gulf veterans and control-group veterans (who served 
elsewhere) to detect differences in symptoms, hospitalizations, and birth outcomes in large cohorts of active duty 
servicemembers. A detailed research working plan is available online at http://www.dtic.dla.mil/gulflinkyvarpt via 
Internet. 

Outside Reviews: 

With the Department of Defense (DOD), VA has contracted with the National Academy of Sciences (NAS) to 
review existing scientific and other information on the health consequences of Gulf operations. Congress has 
authorized VA and DOD to provide up to $500,000 annually to fund the review. In its first report issued in January 
1995, a committee of the NAS Institute of Medicine called for systematic scientific research, including large 
epidemiological studies. Its recommendations urged greater coordination between federal agencies to prevent 
unnecessary duplication and assure high-priority studies are conducted. It made a number of recommendations for 
improvements to programs for Gulf veterans. 

Another nongovernment expert panel brought together at an NIH technology assessment workshop in April 1994 
examined data and heard from both veterans and scientists, concluding that no single or multiple etiology or 
biological explanation for the reported symptoms could be identified and indicating it is impossible at this time to 
establish a single case definition for the health problems of Gulf veterans. A copy is available through 
VA-ONLINE. 

VA also has a standing scientific panel that includes both agency and nongovernment experts to evaluate its 
activities and provide advice in open meetings. VA Disability Compensation 

On Feb. 3, 1995, VA published a final regulation on compensation payments to chronically disabled Persian Gulf 
veterans with undiagnosed illnesses. The undiagnosed illnesses, which must have become manifest either during 
service in or within two years of leaving the Southwest Asia theater, may fall into 1 3 categories: fatigue; signs or 
symptoms involving skin; headache; muscle pain; joint pain; neurologic signs or symptoms; neuropsychological 
signs or symptoms; signs or symptoms involving the respiratory system (upper or lower); sleep disturbances; 
gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual 
disorders. While these categories represent the signs and symptoms frequently noted in VA's experience to date, 
other signs and symptoms also could qualify for compensation. A disability is considered chronic if it has existed 
for at least six months. For claims considered under this special regulation, VA has a 29 percent approval rate 
among claims where the veteran has demonstrated symptoms within the two-year period allowed by law. Among 
the remaining 71 percent, most are diagnosable conditions treated under conventional regulations, while some 
symptoms fail to meet the 6-month chronicity requirement or are found to be related to another known cause. 

Outside of the new regulation. VA has long based monthly compensation for veterans on finding evidence a 



Ill 



condition arose during or was aggravated by service. VA has approved 22.387 compensation claims ot Gulf 
veterans for service injuries or illnesses of all kinds, including 976 claims in which the veteran alleged the cause 
was an environmental hazard, and within that group, 386 claims approved under the new undiagnosed illnesses 
regulation. 



112 



STATEMENT BY SENATOR STROM THURMOND (R-SC) BEFORE A JOINT HEARING 
BY THE SENATE VETERANS AFFAIRS COMMITTEE AND INTELLIGENCE 
COMMITTEE REGARDING MILITARY EXPOSURE TO CHEMICAL NERVE AGENTS IN 
IRAQ; WEDNESDAY, SEPTEMBER 25, 1996; HART 216, 10:30 A.M. 



MR. CHAIRMAN: 

The exposure of our Armed Forces personnel to chemical nerve 
agents is a matter of great concern. The well-being of those who 
served in the Persian Gulf, is an issue that I have vigorously pursued. 
As chairman of the Armed Services Committee, I have included 
provisions in Defense authorization bills establishing the Persian Gulf 
War registry, providing funding for research, and directing a study on 
low-level exposure to nerve agents. Of course, under the lead of 
Senator Shelby, the Committee did a study in various nations in the 
Coalition regarding possible exposure. 

In 1994, the Department of Defense sent a summary to Congress 
to report the findings of the Defense Science Board's review of Iraq's 
chemical/Biological Warfare use during the Persian Gulf War. That 
summary reported that the task force found no evidence of overt, 
intentional use of biological or chemical weapons by the Iraqis. 
Furthermore, their investigation found no credible source of low levels 
of exposure to chemical weapons, making such exposure unlikely. 

1 



113 

Mr. Chairman, we now know that our troops were exposed to 
nerve agent released as a result of postwar demolition of chemical 
rockets at an ammunition storage area in Iraq. The Pentagon 
acknowledged it has known since November 1991 that nerve weapons 
were stored in Iraq, but claims it had not realized U.S. troops were 
involved in the March 1991 depot destruction. 

In light of these developments, it is critical that the government 
continue to identify those who may have been exposed to nerve agents 
to assess their health, and to continue to provide medical care. 

Mr. Chairman, as we discuss these concerns, let us keep in mind 
that we are dealing with more than words or reports. What is at issue 
is the treatment of human beings - men and women who served their 
country. This Committee has previously heard the testimony of 
numerous Veterans who went to the Gulf in excellent health and 
returned with various illnesses and disabilities. Included in the list of 
complaints are swellings, headaches, rashes, pain in the joints, chronic 
fatigue, neurological disorders, respiratory troubles and flu like 
symptoms. 

I believe both the Department of Veterans Affairs and the 
Department of Defense are concerned for the well-being of those who 



114 

served in the Persian Gulf. The Department of Veterans Affairs has 
taken action to address the many mysteries surrounding the various 
ailments, commonly described as "Persian Gulf Syndrome." Such 
actions include the establishment of the Persian Gulf Registry to 
provide health exams and health monitoring of Veterans, as well as the 
institution of various research programs to identify the causes of the 
unexplained illnesses reported by Persian Gulf Veterans. 

I thank the chairman of both committees for holding this 
important hearing today. I look forward to reviewing the testimony of 
the witnesses and working with you to make sure our veterans are 
treated fairly and honorably. 



115 



Opening Statement 

of 

Senator Alan K. Simpson 

Senate Committee on Veterans' Affairs and Senate Select Committee 
on Intelligence Joint Hearing 

on 

Chemical Weapons in the Gulf 

September 25, 1996 



I am pleased to be present today for this hearing to address the 
recent Pentagon reports that U.S. military personnel may have been 
exposed to low-levels of chemical nerve agent in March 1991 during 
post-Persian Gulf War bunker destructions in Iraq. I have been most 
eager to work with my friend, Senator Arlen Specter, the Chairman of the 
Senate Select Committee on Intelligence, in crafting this hearing. I know 
that his concerns for any military personnel who may have been exposed 
to nerve agents are most sincere. I share that deep concern as does 
everyone in this Congress and the last 103rd Congress. 

It is clear that we need to know more about the Khamisiyah bunker 
in Southern Iraq that was destroyed back in March 1991. I have read 
the August 2, 1996 CIA report on the matter as well as statements that 
have been issued by the DOD. Questions still remain. We need more 
information and it is my intent to gather it today in the most productive 



116 

2 

way possible. Today's proceeding is not in any way an attempt to round- 
up "The Accused." It is a good faith effort to ground ourselves in the 
facts so that we might be able to perform our jobs in a thoughtful 
manner. 

It is my hope that by hearings' end, we will have a better 
understanding, for example, of why the UNSCOM report that was 
transmitted to the DOD in November 1991 was not given more 
consideration? Was it because of the "fog of war?" We are soon to find 
out. Why did chemical detectors not go off when the Khamisiyah bunker 
was destroyed by the U.S. Army? Importantly, what was learned from 
this experience? If errors were made, what can be done to ensure it 
does not happen again? These are but a few of the questions swirling 
about. Indeed, I welcome the expert testimony of the VA, DOD and CIA. 
It will be helpful to hear from each of these fine and seasoned witnesses. 



I am well aware of the veterans who believe it is the low-level nen/e 
agent exposures from the Khamisiyah bunker destrjjction that made them 
ill. Many of them contact me. They speak from their hearts. I hear 



117 

3 

them. Nobody wants veterans who have served our nation with pride 
and distinction to be suffering. Nobody. Nobody doubts that many of 
them are ill. But we don't know exactly what is making them sick. 
Researchers have not been able to conclude that the symptoms are the 
result of any one unique illness. That is why a great research, outreach, 
treatment and compensation effort was set in motion during the 103rd 
Congress. We are continuing with this aggressive response under my 
watch as Chairman of the Senate Veterans Affairs Committee -- and the 
effort will continue long after I retire from the Senate. 

I do want everyone to know of the federal government's vast 
involvement with our Persian Gulf veterans. Indeed, the VA will speak to 
that in a few minutes but I do want to enter into the record two 
documents that list all that we are doing for our sick Persian Gulf 
veterans. We are a great nation and we have allocated great resources 
for our sick veterans. 

The VA has over 30 research projects underway. It has three 
Environmental Hazards Research Centers and has announced the 
creation of a fourth center. The VA is also, undertaking a gargantuan 



118 



epidemiological survey and study. It will compare a representative 
sampling of 15,000 deployed Persian Gulf veterans with a control group 
of 15,000 veterans who served stateside or in other locations away from 
Southwest Asia dunng the Persian Gulf War. Results are due in 1998. 

Congress also passed legislation requiring that sick Persian Gulf 
veterans be compensated by the VA -- EVEN IF THERE IS NO 
DIAGNOSIS OF DISEASE. There are 13 categories of undiagnosed 
illnesses for which a Persian Gulf veteran can be compensated. 
Congress also mandated that Persian Gulf veterans receive priohty 
treatment at VA hospitals. 

This is just a smattering of the many ongoing federal activities for 
the Persian Gulf veterans. The other agencies included in the 
multiagency research effort are the Department of Defense, the National 
Institutes of Health, the Centers for Disease Control, the National 
Academy of Science, the Environmental Protection Agency and more. 

I will simply say that this Congress, and the 103rd Congress, 
accomplished a great deal for our nation's Persian Gulf veterans. 



119 



5 

Coordinated efforts are underway to treat them, to compensate them and 
to better understand their ailments. They have been uppermost in our 
minds and for anyone to say otherwise is plain wrong. 



Thank you. I do look fonA/ard to today's hearing. 



120 



vice Chairman Kerrey 

Senate Select Committee on Intelligence 

Opening Statement 

Hearing on the Investigation of Gulf War Syndrome 

September 25, 1996 



Mister Chairman, the Persian Gulf War ended over five 
years ago. Our gratitude and concern for the brave men 
and women who fought in that conflict continues. Our 
nation and the rest of the world owe a great debt to the 
soldiers who fought to liberate Kuwait. Paying the debt 
means we should not let America's victory translate into 
personal tragedy for the soldiers who suffer from unique, 
unexplained sicknesses caused by their service in Kuwait. 

We meet today as part of an ongoing effort to identify and 
understand the ailments which mysteriously afflict many of 
our veterans. The fact our government continues this 
effort so long after the war ended reflects the United 
States' commitment to finding a diagnosis and a cure. 

Our specific concern on the Intelligence Committee is to 
be sure all appropriate collection and analytical 
resources have been focused on this problem. Our 
intelligence collectors and analysts must find and sift 
all the data available about the chemical and biological 
environment of the Kuwait battlefield. When new evidence 
sheds additional light on old reporting, enabling our 
analysts to piece together more of this puzzle, we should 
not criticize people who decided not to act on incomplete 
information. We need to encourage them to continue their 
work and uncover even more information. 

While some may seek to find fault, I see many departments 
and agencies and thousands of people within the military. 



121 



the intelligence community, and medical community working 
diligently trying to find both the cause and the cure for 
this problem. I hope their persistent efforts will 
continue unimpeded and their work will soon pay off. 

We will also today be hearing about chemicals such as 
mustard gas, sarin, and cyclo- sarin. We were fortunate 
during the Gulf War that these compounds were not used as 
weapons against our men and women. These horrible weapons 
should never again be used. Their presence in the Gulf 
theater in the hands of Saddam Hussein is a strong 
argument for the United States to continue to lead the 
international community in the effort to outlaw these 
weapons of mass destruction by all means, including 
ratification of the Chemical Weapons Convention as soon as 
possible. 



122 



( I'nirjl lnli'llis:cni.c Xj.- 



i.liini:ion, 1) (.■ ;i'-ii 



13 February 199' 



The Honorable Arlen Specter 

Chairman 

Committee on Veterans' Affairs 

United States Senate 

Washington, D.C. 20510 

Dear Mr. Chairman: 

Enclosed are answers to questions Mr. John McLaughlin 

received from former Committee Chairman Alan Simpson subsequent 

to the joint SSCI/Veterans Affairs Gulf War Illnesses hearing on 

25 September 1996. If you require any further assistance, please 

do not hesitate to call. 

Sincerely, 



Johii H . Mos^man 
Director of /Congressional Affairs 

Enclosure 



123 



The Honorable Arlen Specter 



Question # 1 . What were the differences between the United 
Nations' reports of November 1991 and May 1996 regarding the 
evidence of chemical rounds at Bunker 73? 

A. Iraqi chemical rockets are externally identical to 
conventional rockets. Prior to the May 1996 inspection, UN 
reporting implied that the UN believed or assumed the presence of 
chemicals in Bunker 73, but no sampling was done, and chemical 
agent monitors did not detect nerve agents. The UN reports of 
November 1991 relating to Bunker 73 addressed the munitions there 
but did not record or document - - either in written, 
photographic, or video form - - information to show if the rounds 
at Bunker 73 had been chemical. The May 1996 inspection 
documented interior design features - - such as plastic inserts 
and burster tubes - - that removed any uncertainty that the 
rockets in Bunker 73 were chemical rockets. 



Question #2. In light of this recent reexeunination of the 
DNSCOM Report, are documents detailing the numerous false 
chemical alarms being reexamined as well? If so, by whom? 

A. DoD has an ongoing effort to reexamine the circumstances 
that caused the alarms to go off. 



Question #3. Why, in your view, did the DoD determine 
that there was no relationship between the UNSCOM document 
and the operations of the 37th Engineering Battalion? 

A. We can not speak for the Department of Defense and believe 
that the question should be directed to appropriate DoD 
officials . 



124 




THE ASSISTANT SECRETARY OF DEFENSE 
WASHINGTON, D C 20301-1200 



1 m 



Honorable Arlen Specter 

Chairman. Committee on Veterans" Affairs 

United States Senate 

Washington DC 20510 

Dear Mr. Chairman: 

This is in response to Senator Simpson's letter, w-ritten as Chairman of the 
Committee on Veterans' Affairs, concerning some additional questions subsequent to Dr. 
Joseph's testimony before the Comminee on September 25. 1996. I have enclosed the 
information you requested, with respect to: the kind of research DoD has carried out on 
the effects of low-level nerve agent exposure to date (Enclosure 1); when the GIS will be 
completed and available for use by researchers (Enclosure 2); and whether anylhing has 
been published concerning the personal communications with Dr. Fred Sidell cited in the 
Report on Possible Effects of OP Low-Level Nerve Agent Exposure (Enclosure 3). 

I have just recently received the responses requested from the various agencies 
involved. I regret the delay in our response. 

Sincerely, 




Stephen C. Joseph, M.D., M.P.H. 



Enclosures: 
As Stated 



Honorable John D. Rockefeller, IV 
Ranking Democrat 



125 



Senate Committee on Veterans' Affairs 
September 25, 1996 

Question 1: What kind of research has the DoD carried out on the effects 
of low-level nerve agent exposure to date? Please explain the kinds of low-level 
exposure research the DoD will undertake with the S3. 5 million recently 
committed to this research? 

Answer: A list of references is included, detailing some of the studies conducted 
by DoD that are relevant to the clinical effect of nerve agents. Also, in combination with 
the Departments of Veterans Affairs and Health & Human Services, DoD has 
implemented an aggressive research program to better understand the symptoms and 
illnesses experienced by Persian Gulf veterans. Enclosed is a copy of "A Working Plan 
For Research on Persian Gulf Veterans" Illnesses," dated November 1996, prepaied by 
the Research Working Group of the Persian Gulf Veterans" Coordinating Board. This 
document contains information concerning the whole research program surrounding 
Persian Gulf illnesses, including research concerning possible low-level chemical 
weapons exposure. In FY96, as a result of new information concerning the destruction of 
Iraqi chemical weapons immediately following the Persian Gulf War, DoD and VA 
committed $5 million to study the health effects of possible subclinical exposure to 
chemical warfare agents. Of the $5M, S2.5M was allocated immediately to fund three 
research proposals. The remainder was allocated to fund scientific proposals to determine 
the feasibility of epidemiological studies, in human subjects, including those thought to 
be near Khamisiyah, Iraq, during the first two weeks of March, 1991, and to conduct 
animal studies, designed to assess the possible long-term or delayed clinical effects of 
low-level or subclinical exposure to chemical warfare agents. The dead line for these 
proposals was February 19, 1997. We expect to fund the best proposals, based on 
scientific merit and military relevance by September 30, 1997. An additional $9.5 
million of FY97 fimds have been allocated to investigate the causal relationships between 
illnesses and symptoms among Gulf War veterans and possible exposures to hazardous 
material; chemical warfare agents; stress; potentially hazardous combinations of 
inoculations and investigational new drugs during military service in the Southwest Asia 
theater of operations during the Persian Gulf War. The deadline for proposals is March 
II, 1997. 

Enclosures: 
As Stated 



126 



us ARMY MEDICAL RESEARCH INSTITUTE OF CHEMICAL DEFENSE (USAMRICD) 

This list of references of published results are from studies conducted by the DoD which are 
relevant to the clinical effects of acute or chronic exposure to ner%'e agents This list is only a 
small subset of published results of studies supported by the DoD on the effects of nerve agents, 
their mechanisms of action, and their response to medical countermeasures. 

DOSE-RELATED ACUTE AND CHRONIC EFFECTS OF 
EXPOSURE TO ORGANOPHOSPHORUS CHEMICAL AGENTS 

REFERENCES 

Albuquerque EX Molecular targets of organophosphorus compounds and antidotal agents on 
nicotinic, glutamatergic and gabraergic synapses. (1994) Baltimore, MD University of 
Maryland Final Report, Appendix II, Vol 2. 

Bates HK et al. Developmental toxicity of soman in rats and rabbits ( 1 990) Teratol. _42: 1 5-23 

Bates HK et al. Developmental toxicity evaluation of soman in CD rats ( 1 987) Toxicol. T. 1 74. 

Baze WB. Soman-induced morphologic changes: an overview in the nonhuman primate (1993) 
MpplToxicol 13 : 1 73- 1 77 

Bertino JR, Geiger LE, Sim VM CWLR2156 Accidental V agent exposures (6 August 1957) 
Unclassified Report Edgewood Maryland: CRDLC, Department of Defense 

Bowers MB, Goodman E, Sim VM Some behavioral changes in man following 
anticholinesterase administration (1964) JNervMentDis. 1 3 8 : 3 8 3 ff. 

Brody BB DPG MIB Scientific Report No 5 Seventy-five cases of accidental nerve agent 
poisoning at Dugway Proving Ground ( 1 December 1 954) Unclassified Report Salt 
Lake City: Dugway Proving Ground, Department of Defense 

Brown EC MDR 158 Effects of G agents on man: clinical observations (19 October 1948) 
Unclassified Report. Edgewood Maryland: USAMRICD, Department of Defense 

Bucci TJ et al. Toxicity studies on agents GB and GD (Phase II): delayed neuropathy study of 
.sarin, type I, in white leghorn chickens. (1992) Jefferson, AR: National Center for 
Toxicological Research Final Report AD-A257357 

Bucci TJ et al. Toxicity studies on agents GB and GD (Phase II): delayed neuropathy study of 
sarin, type II. in SPF white leghorn chickens. (1992) Jefferson, AR: National Center for 
Toxicological Research Final Report AD-A257183. 

Bucci TJ et ai Toxicity studies on agents GB and GD (Phase II): delayed neuropathy study of 
GD (soman), in white leghorn chickens. (1992) Jefferson, AR; National Center for 
Toxicological Research Final Report AD-A258664 

Bucci TJ et al. Toxicity studies on agents GB and GD (Phase II): 90-day aubchronic study of 
GB I (sarin, type I) in CD rats (1992) Jefferson, AR: National Ceriter for Toxicological 
Research Final Report AD-A248617 



127 



Bucci TJ el al. Toxicity studies on agents GB and GD (Phase II): 90-day subchronic study of 
GB II (sarin, type II) in CD rats. ( 1 992) Jefferson, AR National Center for Toxicological 
Research Finai Report AD-A248618 

Bucci TJ el al. Toxicity studies on agents GB and GD (Phase II): 90-day subchronic study of 
GD (soman) m CD rats. (1992) Jefferson, AR National Center for Toxicological Research 
Final Report AD-A258180 

Bucci TJ el al. Toxicity studies on agent GA (Phase II): 90-day subchronic study ofGA (tabun) 
in CD rats. (1992) Jefferson, AR National Center for Toxicological Research Final 
Report AD-A300161 AD-A257181. 

Bucci TJ et al. Developmental toxicity study (Segment II teratology) of tabun m CD rats and in 
New Zealand White rabbits. (1993) Jefferson, AR National Center for Toxicological 
Research Final Report AD- A300 161. 

Bucci TJ, Parker RM, Gosnell, PA Toxicity studies on agents GB and GD (phase II): Delayed 
neuropathy study of sarin, type I. in SPF white leghorn chickens. ( 1 992) Jefferson, AK: 
National Center for Toxicological Research. 

Bucci TJ, Parker RM, Gosnell PA Delayed neuropathy study of .sarin, type II. in SPF white 
leghorn chickens. ( 1 992) Jefferson, AR: National Center for Toxicological Research. 

Bucci TJ, Parker RM, Gosnell PA Toxicity Studies on Agents GB and GD. ( 1 992) Jefferson, 
AR: National Center for Toxicological Research 

Burchfiel JL, Duffy FH, Sin VN Persistent effect of sarin and dieldrin upon the primate 
electroencephalogram (1976) ToxicolApplPharmacol. 35:365-379. 

Carlon HR Compendium of hazard definition data for chemical agents GA, GB, GD, GF, HD, 
HT, and VX, including a selected bibliography AD-B 126270. 

Castro CA e/ al. Behavioral decrements persist in rhesus monkeys trained on a serial probe 
recognition task despite protection against soman lethality by butyrylcholinesterase ( 1 994) 
NeurotoxdTerat. \6:\45-\4S 

Craig AB, Comblath M. MLRR 234 Further clinical observations on workers accidentally 
exposed to G agents (December 1953) Unclassified Report, Edgewood, Maryland: 
USAMRICD, Department of Defense 

Craig AB, Freeman G MLRR 1 54 Clinical observations on workers accidentally exposed to G 
agents (January 1953) Unclassified Report, Edgewood, Maryland: USAMRICD, 
Department of Defense. 

Crowell JA et al. Neuropathy target esterase (NTE) in chickens after treatment with 
isopropylmethylphosphonofluoridate (sarin - type I and II). (1988) Toxicol. 8:50. 

Crowell J A, Parker RM, Bucci, TJ, Dacre JC Neuropathy target esterase in hens after sarin and 
soman (1989) JBiochemToxicoL 4:15-20. 

Dacre JC Toxicological smdies on chemical agents GA, GB, GD, VX, HD and L (1989) In: 
Proceedings of Third International Symposium on Protection Against Chemical Warfare 
Agents, p 179 



128 



DacreJL Delayed neuropathy studies on agents G A, GB, BD, and VX (1989) In: 
PriKeedrngs of the 1989 Medical Bioscience Review Conference, pp 234-240 

Dacre JL Toxicology of some anticholinesterases used in chemical warfare agents A review 

(1984) In Cholmesierases - lundamenial and Applied Aspects, pp 415-426 

deJong RH Drug therapy of nerve agent poisoning (research efforts and medical objectives) 

(1985) Aberdeen Proving Ground, MD: TR85-01 U.S. Army Medical Research Institute of 
Chemical Defense. 

Duffy FH, Burchfiel JL Long-term effects of the organophosphate sarin on EEGs in monkeys 
and humans (1980) Neurolox. 1667 -6%9 

Dulaney MD jr, Hoskins B, Ho IK Studies on low sub-acute administration of soman, sarin and 
tabun in the rat. (1985) AciaPharmacol.elToxicol 57:234-241 

Freeman G, Marzulli FN, Craig AB el al. MLRR 217 The toxicity of liquid GB applied to the 
skin of man. (September 1953) Unclassified Report Edgewood, Maryland USAMRICD, 
Department of Defense 

Gammill JF DPG MIB Scientific Report No 1 Report of mild exposure to GB in 21 persons 
(19 March 1954) Unclassified Report Salt Lake City Dugway Proving Ground, 
Department of Defense 

Gaon MD, Weme J A study of human exposures to GB (December 1955) Unclassified Report. 
Rocky Mountain Arsenal, Denver, Colorado, Department of Defense 

Geller I The effects of cholinesterase inhibition on operant behavior of laboratory rats and 
juvenile baboons. Possible protection against and reversal of the effects with cholinergic 
agents. ( 1 984) San Antonio, TX: Southwest Foundation for Research and Education. 

AD-A149754. 

Geller I, Saws A, Staninoha WB Effects of subchronic soman on avoidance escape behavior and 
cholinesterase activity (1987) Neurotox. /'era/o/. 9:377-386. 

Goldman M et al Toxicity studies on agents GB and GD. Davis, C A: University of California 
Davis Laboratory for Energy-Related Health Research Final Report AD- Al 8784 1 

Grob D, Harvey JC Effects in man of the anticholinesterase compound sarin (isopropyl methyl 
phosphonofluoridate). (1958) yC/w/m-ei/. 37:350-368. 

Grob D, Harvey JC, Harvey AM MDRR 18 Observations on the effects in man of methyl 
isopropyl fluorophosphonate (GB) (August 1950) Unclassified Report Edgewood, 
Maryland: USAMRICD, Department of Defense 

Grob D, Ziegler B, Saltzer CA et al. (1953) Further observations on the effects in man of methyl 
isopropyl fluorophosphonate (GB): effects of percutaneous absorption through intact and 
abraded skin. (January 1953) DA 18-108-CML-3014. Johns Hopkins University and 
Hospital Unclassified Report Edgewood, Maryalnd: USAMRICD, Department of 
Defense. 

Haggerty GC, Kurtz PJ, Armstrong RD Duration and intensity of behavioural changes after 
sublethal exposure to soman in rats (1986) Neurobehav Toxicol. 8:695-702 



129 



Harvey JC MLRR 1 14 Clinical observations on volunteers exposed to concentrations of GB 
(May 1952) Unclassified Report Edgewood, Maryland: US AMRICD, Department of 
Defense 

Hayward IJ et al. Effects of repeated intramuscular low doses of soman in rhesus monkeys. 

(1990) Aberdeen Proving Ground, MD TR88-12 US Army Medical Research Institute of 
Chemical Defense A225002 

Henderson JD, Higgins RJ, Rosenblatt L, Wilson BW Toxicity studies on agent GA. Delayed 
neurotoxicity— acute and repeated exposures of GA (tabun). (1989) Davis, C A: Univ. 
California Davis Lab for Energy. 

Johns RJ TTie Effects of Low Concentrations ofGB on the Human Eye [Medical Laboratory 
Research Report I OOJ (1952) Edgewood Arsenal, MD Medical Research Laboratory 

Kant GJ et al. Effects of soman on neuroendocrine and immune function ( 1 99 1 ) 
Neurotox&Teratol. J3:223-228 

Kant GJ e/ al. Long-term sequelae of soman exposure: hormonal rhythms two weeks post- 
exposure to a single dose (1988) Fund&Appllbxicol. \0A54-162. 

Kimura KK, McNamara BP and Sim VM CRDLR3017 Intravenousadministrationof VX in 
man (July 1960) Unclassified Report Edgewood, Maryland: CRDLC, Department of 
Defense 

LaBorde JB et al Developmental toxicity study of agent GB-DCSM types I and n in NZW 
rabbits and CD rats ( 1 986) Jefferson, AR: National Center for Toxicological Research; 
AD-A168331. 

Marrs, Maynard, Sidell FR Organophosphate nerve agents In: Chemical Warfare Agents. 
Toxicology and Treatment. (1996) John Wiley & Sons, pp 83-100 

MarzuUi FN, Williams MR MLRR 199 Studies on the evaporation, retention, and penetration 
of GB applied to intact human and intact and abraded rabbit skin (July 1953.) Unclassified 
Report Edgewood, Maryland: USAMRICD, Department of Defense 

McGrath FP, Dutreau CW, Bray EH MDRR49 Toxicity of GB vapor by cutaneous absorption 
for monkey and man (April 1951) Unclassified Report. Edgewood, Maryland: 
USAMRICTD, Department of Defense 

♦National Academy of Sciences (1982) Possible long-term health effects of short-term 

exposure to chemical agents. Vol I. Anticholinesterases and anticholinergics. Appendix E 
pp 1-6. 

•National Academy of Sciences (1982) Possible long-term health effects of short-term 

exposure to chemical agents. Vol. 2. Cholinesterase Reactivators, Psychochemicals, and 
Irritants and Vesicants. 

•National Academy of Sciences. (1983) Possible long-term health effects of short-term 

exposure to chemical agents. Vol. 3. Final Report. Current Health Status of Test Subjects. 

NeitlickHW CRDLTM2-21 Effect of percutaneous GD on human subjects (September 
1965) Unclassified Report. 



130 



Oberst FW, Koon WS Retention of inhaled sann vapor and its effect on red blood cell 
cholinesterase activity in man (1968) ClinFharmacoilher. 9 421-427 

Parker RM el al. Thirteen-week oral toxicity studies of tabun (GA) using CD rats (1990) 
/bx;co/. 10: 343 

Parker RM el al. Subchronic oral toxicity studies of sarin Type I and II and soman using CD rats 
(1989) Toxicol. 9 108 

Raffaele RC et at. Long-term behavioral changes in rats following organophosphonate exposure 
(1987) FharmHiochem&Behav. 21 407-4\2 

Rubin LS, Goldberg N4N CWLR2155 Effect of tertiary and quaternary atropine salts on 
absolute scotopic threshold changes engendered by GB (7 August 1957) Unclassified 
Report Edgewood, Maryland CRDLC, Department of Defense 

Russell RW, Booth RA, Lauretz SD el al Behavioural, neurochemical and physiological effects 
of repeated exposures to subsymptomatic levels of the antichohnesterase soman (1986) 
Neurobehav. Toxicol. Teratol. 8:675-685. 

Scremin OU el al. Cerebral blood flow-metabolism coupling after administration of soman at 
non-toxic levels (1991) BrainRschBull. 26 253-256 

Seed JC MLRR 146 An accident involving vapour exposure to a nerve gas (November 1952) 
Unclassified Report Edgewood, Maryland: US AMRICD, Department of Defense 

Shih, ML el al. Metabolite pharmacokinetics of soman, sarin and GF in rats and biological 
monitoring of exposure to toxic organophosphorus agents (1994) JApplToxicol. 14 195- 
199 

Shih TA el al. Effects of repeated injection of sublethal doses of soman on behavior and on brain 
acetylcholine and choline concentrations in the rat (1987) Aberdeen Proving Ground, MD 
TR87-07 U.S. Army Medical Research Institute of Chemical Defense, A182834. 

Shih TA et al. Effects of repeated injection of sublethal doses of soman on acetylcholine and 
choline contents of the rat brain (1990) Psychopharm. 101:489-496. 

Shih T A el al. Metabolite pharmacokinetics of soman, sarin and GF in rats and biological 
monitoring of exposure to toxic organophosphorus agents. (1994) JapplToxicol. 14:195- 
199 

Shih TA el al. Neuroendocrine and immune function two weeks post-exposure to a single dose 
of soman. (1990) Aberdeen Proving Ground, MD: TR90-12 US Army Medical Research 
Institute of Chemical Defense. A225067. 

Shih T A el ai Long-term sequelae of soman exposure: hormonal rhythms two weeks post- 
exposure to a single dose (19S%) Fund&ApplToxicoL. \0.287-294 

SidellFR EATR4082 Human reposes to intravenous VX (April 1967) Unclassified Report. 
Edgewood, Maryland: US AMRICD, Department of Defense 

Sidell, FR Soman and sarin: clinical manifestations and treatment of accidental poisoning by 
organophosphates. (1974) C//n7bx/co/. 7: 1 - 1 7. 



131 



Sim VM PTP 53 1 Effect on pupil size of exposure to GB vapour (20 January 1956) Porton 
Down, Chemical Defence Establishment, UK, Ministry of Defense. 

Sim VM CRDLR 3 122. Variability of different intact human skin sites to the penetration of VX 
(February 1962) Unclassified Report Edgewood, Maryland: CRDLC, Department of 
Defense 

Sim VM, McClure C Jr, Vocci FJ ^/ a/. CRDLR 3231 Tolerance of man to VX contaminated 
water. (October 1964) Unclassified Report, Edgewood, Maryland: CRDLC, Department 
of Defense 

Sim VM, Stubbs JL CRDLR 3015 VX percutaneous studies in man (August 1960) 
Unclassified Report Edgewood, Maryland: CRDLC, Department of Defense. 

Singer AW e/ a/. Cardiomyopathy in soman and sarin intoxicated rats (1987) ToxicolLetters 
36:243-249. 

Ward JR, Cosselin R, Comstock J et al. MLRR 151 Case report of a severe human poisoning 
byGB (December 1952) Unclassified Report Edgewood, Maryland: USAMRICD, 
Department of Defense 

Wilson BW, Henderson JD, Chow W, Schreider J, Goldman M, Culbertson R, Dacre JC. 
Toxicity of an acute dose of agent VX and other organophosphorus esters in the chicken. 
( 1 988) JToxicol&EnvtronHealth 23 : 1 03- 1 1 3 

Wilson BWI, Henderson JD, Kellner TP, Goldman M, Higgins RJ, Dacre JC Toxicity of 

repeated doses of organophosphorus esters in the chicken. (1988) JToxicol&EnvironHealth 

23:115-126. 



KEY REFERENCES 



Ongoing research on the effects of nerve agent supported by the DoD include the following 
extramural projects: 

Neuroprotection from OP-Induced Seizures and Neuropathology 

Cholinesterase Structure: Identification of Residues and Domains Affecting Organophosphate 
Inhibition and Catalysis 

Physiologically Based Modeling of C(+)P(+)-Soman Toxicokinetics 

Toxicokinetics of 0-ethyl-S-(2-Diisoprophylaminoethyl) Methylphosphonothioate [(+)-VX]- 
Identification of Metabolic Pathways 

Molecular Targets for Organophosphates in the Central Nervous System 

Transgenic Engineering of Cholinesterase: Tools for Exploring Cholinergic Responses 

Chronic Organophosphorus Exposure and Cognition 



132 



Senate Committee oo Veterans' Affairs 
September 25, 1996 

Question 2: The DoD is developing a Geographic Information System (GIS) that will be a 
comprehensive registry of troop movement and exposures durmg the Persian Gulf War. When will 
the GIS be completed and available for use by researchers/ Has the DoD developed a protocol 
concerning who can have access to the GIS? 

Answer: The U.S. Army Center for Health Promotion and Preventive Medicine (CHPPM) 
has developed the Troop Exposure Assessment Model (TEAM) which uses geographic information 
system (GIS) technology for conducting space and time analyses of Operation Desert Storm troop 
unit locations / movements and their relation to the Kuwait oil well fires superplumes. The TEAM 
was established in 1993 in response to Public Laws 102-190 (Oil Fires Exposure Registry) and 
102-585 (Veterans' Health Status). The TEAM'S databases include the Operation Desert Storm 
Personnel Registry (supplied by the Defense Manpower Data Center), the Operation Desert Storm 
Troop Unit Movement database (supplied by the U.S. Army and Joint Services Environmental 
Support Group), model and satellite derived oil fire superplume boundaries (supplied by the 
National Oceanic and Atmospheric Administration), and toxicological / exposure factors (supplied 
by DoD and the U.S. Environmental Protection Agency). The TEAM became operational in June 
1996 in support of the above Public Laws. These databases are updated as new information 
becomes available in terms of additional unit movement data from continued records searches, 
improved toxicological data from additional research, and other potential environmental exposure 
data from enhanced study into potential incidents. CHPPM has been assessing and integrating 
other potential Gulf War environmental exposures (i.e., chemical agents, depleted uranium, 
pesticides, etc.) and medical outcomes (i.e., DoD's Comprehensive Clinical Evaluation Program) 
data into the TEAM since July 1996. In addition, the CHPPM has started using the TEAM to 
analyze potential incidents such as the relation of US Forces to the Khamisiyah munitions 
demolitions and Fox/M256 detections. 

The CHPPM GIS is already being used by researchers from the DoD and other Federal 
agencies such as the Department of Veterans Affairs (VA), as well as researchers from outside the 
Federal government working on federally funded investigative efforts on Persian Gulf illnesses 
(PGI). Additionally, CHPPM works with other DoD agencies, including the Office of the Special 
Assistant for Gulf War Illnesses, the Defense Intelligence Agency, the Naval Health Research 
Center and the Defense Manpower Data Center. CHPPM is also collaborating with several 
federally funded investigators. These groups include, the University of Iowa, the Centers for 
Disease Control and Prevention, the VA's Boston Environmental Hazards Center, and the Klemm 
Analysis Group, Inc. 

DoD will be coordinating with the Persian Gulf Veterans' Coordinating Board, Research 
Working Group, to develop and implement a formal procedure regarding researchers' access to 
TEAM GIS data. 



133 



Senate Committee on Veterans' Affairs 
September 25, 1996 

Question 3: I had the opportunity to review the "Report on Possible 
Effects of Organophosphates 'Low-Level ' Nerve Agent Exposure " that was 
prepared by the Persian Gulf Illness ' Investigation Team. One of the citations in 
the literature review is a personal communication from Dr. Fred Sidell — one of 
the leading researchers in the field. Has that personal communications been 
published? I would like to obtain a copy of it. I think it is important for it to 
become part of the public record so that other researchers might have access to it. 

Answer: The personal communication from Dr. Fred Sidell has not been 
published. Dr. Sidell stated that the original discussion was a phone conversation 
referencing symptomatic high-dose nerve agent exposure as compared to low-dose 
asymptomatic nerve agent exposure. However, concerning the citation in the literature 
review, information pertaining to health effects of chemical weapons is located on the 
InterNet and in a textbook which is expected to be published by February 28, 1997. Dr. 
Sidell quoted three references which address the personal communication: 

1. InterNet - www.dtic.mil/gulflink/fmalagt.htm 

2. InterNet - www.gulfwar.org/index.html 

3. The Borden Institute Textbook of Military Medicine, Medical Aspects 

of Chemical and Biological Warfare, 14 January 1997, editor - 
Colleen Quick;TeIephone (202)782-7572 

O 



BOSTON PUBLIC LIBRARY 



3 9999 05983 959 5 



ISBN 0-16-055153-6 





780160"551536 



90000